Fogbow

Stuff involving children tends to get very emotive.

Next defense witness:

Tory Aneis, certified EMTI, certified firefighter, CAN (EMTI doesn’t exist in Florida, but in Wisconsin the “I” is a paramedic EMT that can start IV’s give cardiac and diabetic medications, higher level of care than basic EMT.
She worked for Safe Children’s Coalition, nonprofit that works alongside CPS, and other child welfare organizations. 2016 – 2020. She was a Family Support Intervention Specialist.

She supervised visits, transported children to visits, doctors, school, help families with resources if they haven’t been removed from the home but just needed resources to help the family deal better with children. Worked under a Safe Coalition Manager. The Manager is directly involved in helping determine exactly what is needed in specific situations.
She worked with Charlotte LaPorte, Case Manager. Tory was present as supervising four visits with Maya and her father and brother in October and November 2016.

She prepared notes after each of the visits. She indicates that seeing her notes would refresh her recollection.
First visit –Two other people, a CPI, and a trainee were also at that visit. She was required to intervene if items were attempted to be given to a child in these circumstances. Only a short list of items could be given. No food items were not allowed to be brought in from the outside, I am unclear if that was a hospital rule or child protection org rules. Her father brought IPad, phone, cheesecake, chocolate cake, razor, shaving cream, shower gel, etc. (Sugar exacerbates pain, I have a suspicion her quack doctors never talked to the family about simple things they could do, such as minimize anxiety, avoid large amounts of sugar, play soothing music, keeping conversation pleasant, avoid discussing distressing things around her, etc)

She spoke to Mr K before that visit. She presented visit guidelines to him prior to the visit. What he was allowed to bring, topics of conversation, (Plaintiff is constantly going to sidebar, interrupting the flow). CPI advises on what can be brought, it was not Tory making any decisions, although she carried them out. The items that were allowed in were the shower gel and nail polish remover. The other items were delivered to a CPI. She also was required to take any food items from the refrigerator. No outside food was allowed. She lists all the items that were not allowed in at the first visit.
Some letters were written by Maya and she was required to let them be looked over before being given to addressee
She observed how Maya was physically moving during the visit. She moved freely, energetic, displayed no signs of pain. Roughhoused with her brother trying to get a piece of a game they were playing, twisted around to a reach to a bad on the floor. Her legs were always in the anatomically correct position.

There was a bottle of holy water and holy oil in her room. She doesn’t remember if she took them. Maya told her she was using it to make the cross, sometimes rub them into her arms or legs, she was uncertain where it came from, she gave three different answers where she got it – her mother, came from Poland, one of the Sisters gave it to her.
Maya was participating in arts and crafts, music therapy with a staff person, Ms Kelly. Maya said she loved her room because it had an ocean view.

Her father picked her out of her wheelchair and took her to the bathroom. He closed the door to the bathroom and Maya changed clothing without assistance, the sound of water running in the sink could be heard and Maya had been able to reach up to the paper towels, which were high on the wall without asking for any assistance.
Eating food – Maya had grilled cheese and chocolate cake for her meal on each of the observed visits, the same meal. She kept the food try on her lap while she ate.
She was required to take copy and photo of the letters, the hospital assisted with making copies. They had to be looked over by Didi Cooper, CPI.

She observed May constantly sitting in the “Indian Style” or now know as “cross cross applesauce” position. (You can’t do this with dystonia. Under cross exam even one of plaintiff witnesses said Maya was sitting in this position on her bed when witness entered the room). This witness says she sat like that frequently. She did not ever once show any sign of pain, she appeared to be perfectly happy, clean, well cared for

Second Visit notes: Kyle not present. Just Mr K and Maya. On this visit Mr K met him in the lobby and explained again what he could bring. He brought several bags of toys, games, mascara, tons of items. All of them were allowed to be brought to Maya, she was not denied any of the large number of items Mr K brought at this time. (He testified that Maya couldn’t “get anything” from her family. He seemed unreliable as a witness during his testimony, particularly cross exam brought out lots of things that weren’t really true.)
How did Maya seem physically – playful, happy to see her father, no signs of pain, she danced around (upper body), smiling, laughing, reaching up at the sky while dancing, sitting cross legged, had superhero visited her, the Green Hornet. She also had to take some letters at this visit, that was the same as the first visit.

Not one complaint of pain during this visit. Her legs and feet were in the anatomically correct position during the entire visit.

Third Visit – Halloween
She was dressed in a costume, Harley Quinn, had red and blue hair, mascara, a very short shirt with holes in it, short shorts, lots of midriff showing. Quite a bit of makeup, very high heeled shoes. Tory remarked that this costume was not modest in the least. * Did not observe any difficulty with legs or feet, they were in anatomically correct position. During this visit Mr K asked Maya something about her feet. Maya responded “yes” and then turned her feet inward. She had never had her feet turned inward in any of the previous two visits and in this visit her feet were in anatomically correct position until the father asked her something about her feet. (Even before this witness testimony I had gotten the impression that Maya was highly suggestible and that much of her extreme symptoms were suggested by mostly her mother, but I guess her father was also somewhat involved)

*During Maya’s testimony she talked about the incident where they were photographing her and saying all about how religious she was, how modest she was, she couldn’t stand that people could see her midsection or parts of her body. She had the whole comment section and probably the jury absolutely hating those people for forcing their eyeballs on her 10 year old arms and legs.

Was she able to give her father to take home. A snowman ornament, card for her mother, and a picture she drew for her whole family. He was allowed to take them home.
She seemed happy during all these visits. She had grilled cheese sandwich and chocolate cake also on this visit. She moved her wheelchair using her feet to steer the wheelchair. She reached and grabbed items, reached down from the bed to get something out of the bag that she always kept beside that bed.
She seemed to be being appropriately cared for. If she had any concerns about how Maya was being treated or if Maya seemed unhappy or like she was in distress, she would have reported this to her supervisor.

Fourth Visit
Feet and legs in anatomically correct position, sat cross legged many times throughout the visit. Hugged her father tightly and displayed no sign of having any pain upon touching him in that way. She had been working on science and math homework when Tory entered the room. She said her and the teachers worked on a computer to do her schoolwork. Her room was organized just like a person with OCD. Maya herself pointed out how she organized everything. Maya had done this all herself. Some of the items seemed like they would be difficult to get to, but Maya had had no problem putting those items there or retrieving them. She reported that her costume from the last visit had gotten the most votes in the hospital. Harley Quinn was her costume. (I just now looked it up, yeah, not exactly modest for a 10 year old)

Did she observe an interaction between Maya and three Nurse Practitioners. Yes. Maya was upset that she was only given Tylenol and Maya said she wanted morphine. Witness says in her experience in over 20 years she has seen a lot of people in pain and Maya had not ever shown any evidence of ever being in any pain, but she was now telling the Nurse Practitioners that she specifically wanted morphine. The witness described her own reaction as shocked.

At the time of these visits she was not working for or employed by JHACH, never worked for JHACH. Maya’s safety was witness’ utmost concern and she states that from her vantage point Maya was being treated exceptionally well by that hospital. She actually spontaneously turns to the jury to make this point. The plaintiff did everything they could to object to every form of every question that might allow her to respond that she saw no issues with how Maya appeared to be treated at the hospital.

Lunch break

Suranis wrote: ↑Tue Oct 17, 2023 12:44 pm Stuff involving children tends to get very emotive.

Yes that is true, and good point.

Lawyer argument about the admission of medical records from Tampa General. Judge says the jury has heard lots about this so entering the records doesn’t seem like it can do any harm. The plaintiff says it’s hearsay. The defense says it’s a medical record and just like the jury is going to be able to see thousands of pages of JHACH and they have hears lots about Tampa General and he sees no reason why their records can’t be put in. This is information that was available to JHACH in order to help them suss out what is going on with Maya.

They also wasn’t to put in the Lurie Hospital records as well. These are the two other hospitals that, each on their own, had suspcions of conversion/Munchausen by proxy being possibilities.

The judge says if the plaintiff has specific pages of records they want to redact, hw will consider arguments about that. But not just leave out complete medical records as such.

Nemours records, Mendez records, etc. The defense wants to play doctor depositions today, so they want these medical records in. I really wish they would put on witnesses in person. I think it makes it far better for the jury to judge demeanor.
The jusge actually says “At some point the defense is actually allowed to defend themselves”. I’m glad to hear him say this. He says that if a doctor had observations of Maya and Beata and has opinions, if plaintiff doesn’t like it they can cross exam.
Apparently Dr Mendez is going to have an opinion that is not helpful to plaintiff. I can’t even believe Mr Anderson really thinks that just because a doctor has an opinion he doesn’t like that is grounds for not allowing his records to be admitted as evidence. He’s a real wing ding as an attorney. I credit the judge for not just getting off that bench and strangling Mr Anderson at times.


Cross exam of Tory Aneis
The witness is sounding too defensive. On direct exam she had been asked if she ever saw Maya display any signs of being in pain. She said not once. Now on cross she is being shown her notes where Maya mentioned one time that the port from her Mexico trip hurt. One time she said she was in pain when Tory first got in the room. One time Maya said she sometimes feels pain before sleep and when waking up. And one other time. This is coming across very badly to the jury because she is getting angry, showing anger, and being defensive. She could just as easily smile and explain that brief one time each visit mention of pain followed by 1.5 hours of family visit where she never brings it up again, never behaves like she’s in pain. The arm that supposedly hurt where the port was is being used normally, she’s even touching that area. All that could be said, but she’s getting too defensive. Not good.
Now she’s being asked about Charlotte’s notes.

She was required to take photos, she took one with her camera and one with Mr K’s camera. That one was shows feet turned in, however, it does not look like tured in from dystonia. Dystonia is not a problem with the feet, it’s a problem with the lower legs being so cramped and tight that it makes her feet turn in. You can see in the photo that her legs are not cramped, they are very relaxed. Many girls when feeling “coy{“ will turn both feet in the way Maya’s feet are turned in this photo.
Maya brought up not being able to sleep one time. She did state that she was not happy. She’s being asked if Maya told her that the hospital staff doesn’t care.

This witness is destroyed because of her demeanor. She’s a disaster at this point.
She observed there was a camera in the room. She did not ask for a copy of any video.
She doesn’t know what went on at the hospital when she wasn’t there.

No Re-direct. They probably want her out of there asap.

Jury questions
Judge sends jury out because there are a number of questions. Witness is asked to step outside

1. In the Harlequin photo it shows a large bracelet with tons of charms, did you see any lesions or abrasions at the point of contact or in the area of that bracelet?
2. What reason was the observation stopped? They can’t decide if the question is about why she stopped going for visits or why the camera observation stopped
3. You were asked on your observations abut your description, are you asserting that Maya, Kyle, and Jack were being all happy while you and your team searched through her room, etc, etc. It’s a super rude question judgmental about how they perceive. Judge going to ask it
4. Your testimony for your four occasions portrays Maya as having some physical difficulties but getting around (that was not her testimony, she indicated NO physical difficulty Maya was having). Do you have video, photos, etc to corroborate your testimony. (JHC these jurors)
5. A fellow retired law enforcement officer asking here, about the old IV port having pain, is it required for her to report this? Court sustains both sides objection to this
6. Is it your testimony that a young girl is happy to be away from her family at a hospital or is she happy to be happy visiting her family?
7. Are you saying a person is not in pain when you see no symptoms of pain even when they say they are in pain. (This is where the defense blew it by nothaving a CRPS expert)
8. Did you not say her room was completely organized? In the photo shown it was not organized.
9. Does CPI check investigator Beata and what did they find? Huh? Not going to ask this question
10. Have you been trained on how CRPS pain react to patients? (same person wrote 9 and 10, oh lordy)
Judge brings witness back in to ask her what was the reason her observations were stopped. She says at one point the case transitioned between CPI and Safe Children’s Coalition, so she was no longer needed because she worked for SCC now out of the picture.
Answers:
1. She needs to see the photo to see how many charms are on the bracelet. Can’t tell. She did not notice any abraisions or lesions
2. Same as above answer. The SCC not longer involved because it was assigned to other agency.
3. (This is the sarcastic question for this witness.) She says the characterization as the question was asked was not how it happened. The items taken from jack was done outside the room in the lobby.
4. Not correct. She moved around freely without limitation
5. I took photos of the letters, checks, food, refrigerator, required to take a photo of Maya and my notes are very, very detailed and was assigned to document in that way.
6. Maya stated that she was happy to be away from her mother’s anger, which is documented in my notes (!!! That didn’t even come up in questioning) and she stated that she was very happy to see her father and Kyle. (Wow. And here’s the thing. That would have been way more powerful had she been able to manage her demeanor on plaintiff questioning)
7. I am stating that a person can state that they are in pain and a person who is assisting them can say “where” and try to observe and see if the person stating they have pain is demonstrating that they are avoiding using, touching, etc. Maya never once showed any sign whatsoever of having any pain. She never once pushed a button to ask a nurse to bring her pain meds. She answered much more and I had a hard time keeping up, but I found her answer to this may have redeemed her from the disaster of cross exam. She seemed very compelling. This judge actually allows the witness to elaborate and narrate on jury questions. She done good on this one explaining why her notes mentioned very minor mentions of pain, while Maya never demonstrated any pain or inability to do anything because she didn’t feel good.
8. The part of the room over to the left side by the window where all her shoes and other items are organized. Not sure if they are shown in photos.
9. I have not been trained in CRPS. She knows it’s a complex pain disorder, she would have to google it.
Defense followup:
With respect to your role, you were there as an independent observer on behalf of CPI, but not associated with the hospital? Correct.

Plaintiff:
You said that Maya never complained about any pain the whole time you were there, what about if someone touched her leg? She can’t answer that, only what she observed. Judge sustains an objection when Mr. Anderson accuses her of advocating for the hospital.
When one of the nurses tried to touch Maya’s leg Maya squirmed and said “it hurts”. He’s showing her a report, and she says this is not my notes or report. Judge sustains objection. Sidebar.

(Apparently these are from Charlotte’s notes. Mr Anderson was trying to point out that this was on the same day.)
Do you recall if you said anything in your report about Maya being touched lightly? She doesn’t recall. He gives her a report, she asks where, he says I’m asking if you know. She offers to paraphrase what she wrote about the Nurse Practitioner touching Maya’s leg. She says she documented that they talked about how good she was doing, Maya told them about hunting for shark teeth on the beach, Mr K asked the Nurse Practitioners to say hello to a certain doctor for him, she did not document anything about anyone touching Maya’s leg.
She reiterates that she took a photo of Maya’s face to upload in their system as is standard practice. As a courtesy she took photos for Mr K and she did not specifically zoom in on Maya’s legs. (She’s getting frustrated again. She’s not as bad as the first cross, but he’s going to go on and on until she screams, I think.)

He’s now wanting to show that she’s lying because she didn’t take video of everything Maya was doing. She says this is a family event, and I documented in very very good detail. My notes are in detail and accurate. I was not there to take photo and video. That would be inappropriate for her to video a family visit when they are playing together as a family.
She’s being asked about video from the hospital and her answer is “I already testified to this”. God, she’s getting upset and angry again.

Now Mr Anderson is starting to really badger her, seems like he’s trying to get her to display the worst demeanor possible.

More jury questions
(Jack K is smiling and laughing. I guess he should be at this point, but should be advised not to act that way in front of the jury)
Judge tells them that all documents in evidence will be back with the jury
1. Were you paid to testify? Absolutely not


No further follow up. Defense is releasing her.

Video deposition of Dr Behar Posey
Employee of JHACH
( In Florida it’s normally the “other side” that is doing the depositions. So, there is an antagonistic tone to these depositions. It would probably be much better for the defense to put on their witnesses in person instead of showing a deposition taking by plaintiff. Even though they probably feel like the answers she gave are helpful to them, the demeanor for witnesses during a deposition is often less than friendly. The plaintiff had witnesses that faced the jury, smiled, joked, and established very good rapport with the jury. Another problem with deposition is that they are told by “their side” to answer short and sweet with no embellishment. However, if they are trying to present this as their own witness testimony it comes across as gruff, like they don’t want to be there, very unfriendly.)

Showing her an exhibit. This is her note of October 7, 2016, she reviewed prior to depo. She’s duty bound to keep accurate records. And she’s duty bound by ethics to keep accurate records.
Differential diagnosis definition is a list of things that you consider after getting a history and examining the patient. It can be a complete list, there may be things missing, depends on whether you can think of every possibility or not. This is done after examining the patient.
First condition – withdrawal. The child had received ketamine. The presentation of the child and the symptoms could be explained possibly by withdrawal. Her father had told this Dr that she had been placed in a ketamine coma in Mexico, that she had had many infusions since then, including one the day before. Both physical and mental dependence. She conferred with an anesthesia doctor about ketamine, discussing the dosage, and whether it’s habit forming

Second condition – CRPS. She put this down because the father stated that she had this condition

Third condition – constipation – the father said she had a history of it, had just been seen in the emergency department for constipation and she was presenting with abdominal pain

Fourth condition – other inter-abdominal issue – the father said she had just been seen in the emergency department with abdominal pain. There are multiple possible reasons for abdominal pain that have to be considered, especially when they were just seen for that and the complaint was still persisting.

Fifth condition – UTI = had to be condisered in any female with abdominal pain

Sixth – Psychogenic – another thing that has to be considered with any child with abdominal pain. Depression, anxiety, conversion, all kinds of psychogenic conditions can cause abdominal pain.

Impression/Diagnosis – This is the working diagnosis when the child is admitted to the hospital. This is after the differential diagnosis, but doesn’t mean it’s the final diagnosis. It’s listed as RSD. Explain why it’s not the final? There has to be a diagnosis. She could not rule any of the others in or out at this time. It would not have changed anything, there is an admitted diagnosis, doesn’t mean it’s correct or incorrect. She explains it’s not the “best” guess. It’s the working diagnosis. She could not rule any of it in or out in the emergency room.

Munchausen by proxy was included as one of the things she was considering within the psychogenic. The emergency department does not have a way to fully evaluate for Munchausen by proxy. That would be a different department and involving lots of evaluation. This doctor gave a presentation on Munchausen by proxy at a professional conference. She says you do not make a diagnosis of Munchausen by proxy based on a single emergency room visit. She worked in the emergency room.

She relayed information to Dr Vos regarding Maya after the admission to pediatric intensive care unit. She relayed the child’s presentation and that the mother was demanding 1500 mg of ketamine and that she was unable to administer that in the emergency department. Also the child was going to need to be admitted to ICU to provide such high doses IF that was what the child needed.

She had no reason to take any further steps to pursue a diagnosis of Munchausen by proxy because it’s not appropriate of her to do that based on emergency room presentation. MBP is a form of child abuse. She did not follow the case after she admitted her to the ICU

When was the first she heard that MBP had ben reported? Months later, she thinks Maya was already out of the hospital by the time she found out what further happened in Maya’s case.

In her position she is responsible for patient complaint, review of medical records, as Vice Chair ws their a pathway for MBP – she says NOT in the emergency department. (this is defense witness, but questions are being done by plaintiff, so again, these are not ideal IMO for the defense to rely on depo, would be better to bring her in person). She’s getting the point across but it’s not friendly. It’s dry, if she can answer yes or no only she’s doing that.

How many cases of child abuse in 5 years>? She doesn’t have a number. Probably more than 100, maybe in the range of 500.

She was not consulted further. She was informed by a resident who was talking to another resident. She asked what happened. She says she was surprised. Her impression of Beata was that she was angry, demanding, shouting at her husband, insisting on higher doses of ketamine, she wouldn’t let her husband touch her child, she wouldn’t allow me as a doctor to do anything with her child unless I gave her high doses of ketamine. She allowed the nurses to draw blood and that is about all she allowed.

Beata resisted a CT and an ultrasound. She would only allow these tests to be done if Maya was given 1500 mg of ketamine. That was the only thing she would accept. The doses that are allowed in the emergency room is in .5 to 4 mg/kg range and the dose Beata wanted was in the 45 – 50 mg/kg which is absurd and not something we are trained or allowed to give. (It’s been explained by others that those doses require a large amount of preparation, intubation, all kinds of setup for the possible life threatening emergencies that can arise during administration of that. This is the kind of thing done by an anesthesiologist. Many pain management doctors are anesthesiologists. Maya’s doctors were set up for that, although still dangerous)

To her knowledge is that Dr Hanna in Clearwater is the one who did that. She tried to contact him, he was not available to speak with her. She also called the anesthesiologist on call and she spoke with the ICU staff. She did not speak with anyone else outside the hospital.

Primary care physician, she did not reach out to him. (I don’t know why she would). The father told her the diagnosis was made 1.5 years prior to her presentation. She did not speak with any psychologist. It’s not something they do in the emergency department. That is an inpatient consult, not an emergency.

She thought a psych consult would be aproopriate. Is she aware of CRPS. She says she’s aware, not an expert. If she was going to consult, she doesn’t have a specific name, but there is a CRPS clinic available to JHACH. Dr Hanna office confirmed what she had received the day before. Beata was asking for 250 mg higher for a child that weighs 30 kg yes, that is a huge increase.

In the emergency department we give it as a bolus. Her doctor gives it as an infusion. That requires staff and lots of equipment. Nurses are not allowed to give infusions of ketamine in an emergency department in the state of Florida. We don’t have the staff to dedicate a doctor to give a long infusion of ketamine. We could not give 1500 mg as a bolus. Infusion requires a pain management specialist to supervise.
(Also, her doctor had given large infusions in the last two days, and 5 in the last 7 days. And he referred her to them for abdominal pain.)

Dr Elliot, Dr Patel, and Dr Druzhinin are the three anesthesiologists she knows the most. They are usually on call. The decision to admit Maya to intensive care was due to the inability to administer ketamine in ER by infusion. ICU would then further consider what pain management or other treatment might be necessary after that. Beata’s concern was that this doctor give her a specific dosage of ketamine. She ws not amenable to any other pain management. She was pushing her opinion of how the child’s pain should be managed. She unwillingly complied with admission to ICU after Dr Behar said she would not give ketamine under any circumstances.

Beata did not ask for an infusion, she simply asked for 1500 mg of ketamine. This doctor does not have personal knowledge of what was done by Dr Hanna. She never spoke with Dr Smith.

Her concern was for the safety of the child. She could not comply with what the mother was asking in the emergency room. The child needed further diagnosis for the abdominal pain, (which is not CRPS) , the mother was not allowing Dr Behar to do any testing to figure anything out. So, she had no choice but to admit the child to ICU so that IF the anesthesiologist was amenable to giving a high infusion of ketamine, it could be arranged in ICU. And also further diagnosis could be made.

She did not know why Beata was so insistent on this treatment, Behar gave her smaller doses of ketamine and other things for her pain.

She says she is not a specialist in pain management. She also stated Beata was erratic. Belligerent, demanding, nothing negotiable, not concerned about the child’s abdominal pain, she was only concerned with asking for ketamine constantly. Her interaction with the K family was about 2 hours. Dr Behar states unequivocally that the mother was acting inappropriately.

We have children come to the emergency room with all kinds of parents with all kinds of psychological behaviors. She did not report her to the abuse hotline because she didn’t think it rose to quite that level during the two hours she had to deal with them. She wouldn’t base an abuse report on 2 hours of belligerent and demanding behavior.

Even though the questions being asked were done in an adversarial manner, this witness came across very well. She kept her composure, did not allow the lawyer to trip her up, and sounded cool, calm, and collected. She would have probably been a superstar in person. But I think she gave the jury a very good idea of Beata's behavior.

Defense witness - deposition of Dr. Bonnie Rice- Nurse Practitioner

Goes through all her credentials, they are impressive. Ph.D. from Case Western

She obliterated the plaintiff. At the end of the day the plaintiff wanted to eliminate her entire testimony…because.

The judge decided that he needs something more than just a vague statement that he testimony easn’t to your liking. I am QUITE sure her testimony wasn’t to their liking.

The depositions can be hard because each side is marking each part of the depoisition that they want played. For instance 1:55:15 to 17:43:44. And then someone is taking the deposition and pulling out those sections. So, there are often times when the break is sudden and now it’s a defense attorney and then it’s a plaintiff attorney asking.

Donna Rice worked for Tampa General and the time period she is testifying to is October/November of 2015. (This is after Maya has already gotten the desired diagnosis of CRPS, but for some strange reason although the ketamine treatments are hugely successful according to the family they keep having to take her to other hospitals and doctors for all these symptoms.

Rice is well spoken, intelligent, and right off the bat she said her work with Maya was the most frustrating in her entire career. Maya was getting inpatient physical therapy treatment, occupational therapy, and a certain amount of psychological treatment. Normally they encourage a parent to stay in house so the child has someone in the family, but Beata’s presence seemed to make things worse instead of better. She would set up an office at one side of the room with her laptop and cell phone and sit there and work much of the time. Maya several times expressed that her mother is always working and she doesn’t feel like her mother spent enough time with her.

At some point the whole team agreed that Maya would always demonstrate progress in her ability to do pretty much everything including feed herself, use her legs and arms, range of motions, everything else. Then Beata would walk into the room and instantly Maya couldn’t do anything. She would start whimpering that she had pain, she would be unable to move her arms or legs and she would tell her mother “you are going to have to feed me”. So, it was agreed that they would suggest that Beata would stay away for a few days and see how Maya managed. During those days Maya would be far better, she would make progress. Then, her mother returned and all the sudden the mother said something like “oh look, I think I saw your eye twitch”. Then Maya said she had blurry vision. (From that point on Maya claimed to have blurry vision). Also, Maya claimed that she fell from her wheelchair and laid on the floor in her room calling for help and nobody came. She was asked by different people to explain what happened and she gave at least three different stories. So, the hospital decided to put her into a room with video capability because they really couldn’t get straight answers from her. And she couldn’t even tell them when she fell, she kept changing her answer, but it was always within the last few days when her mother wasn’t there.

The witness expressed over and over again different examples just like I mentioned. I will include the video, she is at the very end and her testimony lasts just over an hour. I think an hour and 10 minutes. There is only a few minutes of judge and attorneys at the end, so if you start about 1:30 minutes before the end you can hear her testimony.

She also mentions about Maya holding her feet inward which mimics dystonia, but they are specifically working on her muscles and there is just no muscle problem in her calf to explain why she is turning her feet in. (I don’t know at this point how much of the dystonia was ever real, there are just too many credible health care witnesses that say she does this during times when there is no cramping. But I can believe that there may be times when it is real. And from what I can see it seems to correspond to times when she’s on these huge doses of steroids and other meds. Tampa General weaned her off all those, but I think she went back on them after going home)

This witness explained that in her opinion there really wasn’t anything her team could do for Maya. Maya made progress when mother wasn’t around. So what is going to happen when she goes home.? And the whole team decided that both Maya and the mother needed intense psychiatric treatment. So, the released her with recommendations and a referral to a psychiatric center. They recommended inpatient for Maya and outpatient for the whole family with more intensive for Beata since Beata’s relationship with Maya seemed to be the one that affected her the most. They did note that sometimes when the father would come in and he might make a suggestion of something all the sudden she would display a symptom related to what he asked her. So it wasn’t just the mother although mostly the mother.

They had obtained records from Lurie but they were transferred in a format difficult for them to access. When they accessed it they found that Lurie had also done a full workup of testing for Maya and also came to the conclusion that at least some of her issues where psychological. They mentioned conversion as a diagnosis.

Beata had taken Maya to multiple hospitals for full workups even though she had this CRPS diagnosis from the clinic and that was the diagnosis the family locked on to and wouldn’t let go. Even as failure to get better from the treatments drove them to take Maya elsewhere, they insisted those treatments were working jus

The defense got nothing from her besides she’s not an expert on CRPS, which she never claimed to be and wasn’t presented to be.

Catching up on testimony I've been missing here. Lots going on at work. Thanks again for keeping up with testimony. I want to note that as a workers comp paralegal, my attorney and I really hate taking on most nurse cases. Nurses tend to over treat and self diagnose. I'm not saying all nurses do, just most of those we've represented for disability. Most tend to drag their cases out out beyond what is necessary.

Seeing testimony from providers noting that Maya reacts to her mother and lesser extent her father's comments about symptoms makes it appear she is either trying to please her parents expectations. Maybe she feels guilt for the family having to spend so much money on treatments. Maybe she wants mom's approval and attention. I've seen parents enmeshed with their children when I did GAL work and it is very toxic. I hope the jury sees a lot of this and doesn't rule just on emotion. I know a lot of people have kind of fallen into a conspiracy hole about CPS and hospitals stealing kids. Not saying mistakes don't happen, but I don't think the hospital did anything wrong here based on what they were seeing and experiencing.

I don't think Maya has CRPS in any way. I have CRPS clients and their lives are forever changed. I like Rivit's medical time line. This girl does not meet the Budapest Criteria for CRPS and I think mom simply plucked this diagnosis off the internet. Mom had serious mental health issues and I'm starting to think dad was mentally exhausted by mom's issues.

I had some additional thoughts on the testimony of Bonnie Rice. She confirmed something that I had suspected about any pain that Maya had. When I first heard about this case it was a very good description of what I went through and I automatically believed what the family had said. Then I watched the Netflix special and pretty quickly into it I started getting puzzled because CRPS is not muscle pain. And that was all I ever heard until all the sudden she shows up at a CRPS clinic and her mother had a textbook, i.e. right off the pages of a CRPS web page, it turns out. But I didn't know about that at the time. But I was seriously questioning how this kid had CRPS within about 30 minutes into the special, if not sooner.

Things are coming more and more into focus during the trial, as often happens during a trial. I was already suspecting that Maya had muscle pain. That was based on her own description of it. It was "my muscles hurt all over my body". She was on huge doses of steroids for her asthma and that seemed like another treatment the mother was insisting on, just like she was insisting on ketamine and nothing else. Turns out during Bonnie Rice's testimony she said the referral to Tampa General included a diagnosis of steroid myopathy. Muscle pain from long term use of high doses of steroids. In 2015 she had been referred for inpatient treatment at Tampa General by Johns Hopkins All Children's Hospital because she was basically not even feeding herself. She complained of not being able to use her arms or legs at all, had to be carried to the bathroom, fed by a parent, couldn't do simple tasks for herself. She was referred in order to try to get her to a point where she could do these things for herself.

Part of the treatment at Tampa General was to wean her off the steroids because muscle pain will cause her to continue to not be able to use the arms and legs. I think the picture is becoming clear as to what her pain really was, and why Beata sought out some other explanation and honed in on the CRPS.

During her stay at Tampa General not only was she weaned off the steroids, she was weaned off most of the opioids she had been on. Rice said they don't actually tell the child she's getting a lower dose, because they can psychologically believe that because they are getting less pain meds they have more pain. So, they just monitor and see how the reduction in pain meds is doing as far as can she still move whatever little bit she was willing to move. So, they got her off the steroids, they saw no issue with the muscles aside from atrophy, and weaning her off the pain meds didn't cause her to complain more about having pain.

They weaned her to the point where she only got single doses every now and then. If she had CRPS pain she would have been screaming bloody murder with no pain treatment beside an every now and then dose.

Eventually, the entire team at Tampa General were convinced that Maya's problems were mainly psychological. They came to that conclusion because without the meds she was fine - no asthma attack, and apparently little if any reporting of pian. She would actually make progress with using arms and legs until her mother entered the room. Then, all the sudden things she had been doing stopped and she couldn't do anything. Upon seeing her mother she would actually start holding her hands in a "spastic" position and tell her mother "you're going to have to feed me". Those same hands that she had been using throughout the therapy session.

She was seen by a neurologist at Beata's insistence and that neurologist told the team "she's faking it". This came out in Bonnie's testimony, not sure why it was allowed to be played. I am assuming that neurologist will be testifying as well.

There were lots of argument about whether her treatment at Tampa General could come in, the plaintiff fought tooth and nail against it. But it corroborates all the stuff that presumably we are going to hear from the JHACH witnesses. And this witness' testimony also indicates that Maya was capable of telling tales and faking symptoms, which is what JHACH also believed a year later.

Beata was very resistant to any suggestion that any amount of Maya's problems were psychological in nature. Ms Rice indicated that they always follow up with families after they get home, often reaching out by phone to see how things are going and if they need any recommendations or anything else. They sent Maya home with instructions about continuing the various kinds of things she was doing at Tampa General to try to feed herself, comb her hair, etc. And also they referred the family for psych treatment and suggested strongly that Maya get inpatient treatment. Ms Rice indicated that she knew Beata was not open to any of that, she was insisting that all of Maya's problems had a medical basis other than psych. When asked if she knew if the family had followed up, Ms. Rice indicated that when she tried to call Beata to follow up Beata never answered her calls.

When I put this on a timeline, this falls squarely before Beata spoke to a client of hers whose daughter has CRPS. Beata researched it on the internet. She arranged for Maya to see Dr Kirkpatrick at the CRPS clinic. In between the research and the appointment with Dr Kirkpatrick, Maya had an appointment with another doctor. Beata told that doctor that Maya had been diagnosed with "RSD" (I can't remember if CRPS Type I was still being called RDS at that time, but I guess so).

It was at this time that all the sudden Beata started describing Maya's medical problems as being related to a sprained ankle, "burning" pain, and in her limbs. That is right off the page of just about any webpage that will come up if you Google CRPS. Sprained ankle is the most common cause of Type I. Prior to this, at every single hospital or doctor Maya said she had muscle pain all over. Which went away essentially at Tampa General after weaning her off the steroids.

And just for FYI, if you have other pain along with CRPS, you don't notice the other pain. That is an issue a lot of CRPS patients deal with. We can get other medical issues that normally you don't know you have except for some pain you have. And you don't feel it either because you have the CRPS pain not under control, or it's under control, but the amount of meds it takes to control it masks any other pain you have. So, any suggestion that she had CRPS pain along with the muscle pain but just forgot to tell any doctor about the burning pain that feels like she is on fire, but told them about the muscle pain is just plain absurd.

Dr. Rice's testimony. Very good point she made regarding medical knowledge and physical functional knowledge. I always warn my clients who I suspect might be exaggerating, they better give full effort in functional capacity evaluations because the therapists can tell if you are giving full effort. When my Dr. witnesses see the FCEs of those patients that did not give full function, they fold in testimony and our case can collapse. Most doctors want to believe their patient's complaints. But they will turn when confronted with surveillance or FCEs showing the patient doing things they told their docs they couldn't do.

I thought I read or saw in the doc that Beata lost a child between Maya and her brother, but I could be misremembering. This testimony points out there was a battle between Maya and her mom. What if mom had her own issues (being abused by her dad) and Maya felt the way to get her attention was to be ill since mom took care of ill people? (Maya complaining mom is always working). This just ballooned out of control and kept growing? Mom being a nurse just felt she had to fix Maya. This is a great case for psychiatry study. Think dad is continuing on this crusade out of guilt? I'm babbling now, had a couple mimosas watching this today on my day off.

Maclilly wrote: ↑Wed Oct 18, 2023 1:00 pmThink dad is continuing on this crusade out of guilt? I'm babbling now, had a couple mimosas watching this today on my day off.

That's the same feeling I've gotten just from reading the recaps of the testimony and story in general here, so maybe you're not babbling as much as you think

This is just a fascinating case, and tragic. That girl is going to have lifelong issues from this - she may never be able to be a truly functioning adult, and that's really awful.

I don't know about Beata losing a child, I had not heard that, but I'm not aware of anything outside of the Netflix and what has happened in court so far. I may have missed some testimony though.

Everything else in Maclilly and KG - yes, agree. Not babbling there, and yes, I think dad probably does have guilt and he seems to have taken on Beata's crusade about Maya having medical problems and the family is continuing to resist any psychological treatment even though if they believe in the CRPS diagnosis, they should still be getting psych treatment. I know this sounds awfully judgmental, but I think they would have a hard time getting on the witness stand to argue how damaged they are so they can get a huge payout if they had treatment to help them cope.

Work day Wednesday directed verdicts – where they stand
21 A & B Directed verdict: - He denies directed verdict on these two counts
Count 5 C
as to Jack Kowolski individually – Florida law under negligent infliction of emotional distress there is a physical impact requirement. Judge spent time discussing the propriety of that requirements. Florida’s law determines that too many people would fake these claims. Oh, boy the judge is all in that if any case should change that law this would be that case. (I will state again I think the defense made a huge mistake in not hiring a CRPS specialist to painstakingly go over her history. Because of that, there is no choice for the judge or jury but to believe Maya has CRPS, they have to go by what witnesses say on the witness stand.
Kowolski contends a number of items that were physical impacts, but each one of those do not qualify as physical impact. Directed Verdict granted

As to Maya Kowolski he is keeping it under advisement, but inclined to deny directed verdict.
Count 18 as to Mr K individually keeping it under advisement, inviting lawyers to give him more information
Count 20 – fraudulent concealment of the EEG tape – only for specified time period. Granting motion, no evidence of damages or reliance
Count 14C = continue under advisement. Wants to see more information about impact to Maya
Count 5 – Battery – transfer to EEG room and time in EEG room. Need to see testimony that a battery occurred, haven’t see it yet. (Plaintiff case is over, not sure I guess he’s allowing then to enter new evidence in a rebuttal or something?
Punitive damages in respect ot hug/pat on leg – granting directed verdict
False imprisonment – previously denied DV motion, took under advisement the first week – deny motion for dv on punitive damages for this time period, now he’s going to allow this to go to the jury.

So basically the judge reluctantly granted a directed verdict on one count and the defense lost everything else. While some are still under advisement, the judge sounded like he’s going to allow pretty much everything to go to the with just a couple of exceptions, one granted today and one granted the other day during arguments.
So, the defense is not doing well here. And they are not doing well with very many of the folks in comment section, and those are the kind of people that might be on any jury. Combined with some of the sarcasm I’ve seen in questions by the jury I think the defense might as well just plan on writing a great big check at this point. They should have hired a CRPS specialist to go over all of Maya’s complete medical history in date order, the evidence is right there to support all the suspicions that THREE DIFFERENT facilities had that there were mental health issues driving Maya’s complaints.

Ya. But conversely a genuine CRPS Specialist might not have wanted to get in front of the public on this, as the way this has been presented he is asking to be threatened and attacked by the mob. People have lost their jobs due to misguided social media pressure.

[quote(I will state again I think the defense made a huge mistake in not hiring a CRPS specialist to painstakingly go over her history. Because of that, there is no choice for the judge or jury but to believe Maya has CRPS, they have to go by what witnesses say on the witness stand.[/quote]

thanks for all the great reports on the case.

Akshully, the jury (nor the judge) doesn't have to believe anyone from the stand. They can believe, ignore, give whatever weight or no weight to anyone's testimony.

Suranis wrote: ↑Wed Oct 18, 2023 4:22 pm Ya. But conversely a genuine CRPS Specialist might not have wanted to get in front of the public on this, as the way this has been presented he is asking to be threatened and attacked by the mob. People have lost their jobs due to misguided social media pressure.

It is exceedingly clear that social media absolutely believes this girl has the worst pain condition ever and that the hospital are evil. So, you may be right about that. Any suggestion that she doesn't have this condition meets with getting banned from comment sections. Even when they politely state their opinion. There are at least two I have seen on the comment that say they have it, say they don't believe she has it, but probably has SOME pain issue and they get absolutely shunned and accused of being trolls. So, yeah, if the hospital had a specialist that was prepared to opine that while she absolutely reasonably had muscle pain she doesn't show the right progression or make the right description (until her mother researched it) of CRPS - that person would likely want to hide and probaby just appear on zoom and probably with a disguise.

Prior to testimony, judge goes over exhibits. Plaintiff does not want certain records to come in. They are signed by the Kowokski’s indicating these are records that they knew about it. It’s coming in

3028 – Record from Dr Hanna 10/5/2016. Dr Hanna is the CRPS doctor that had been giving Maya the highest doses of ketamine she ever had and doing them with frequency. This record is a referral to a nutritionist where she states that the referral is being given due to Maya be malnourished. The plaintiff does not want this record to come in. It’s dated 2 days prior to admission to the JHACH. They state that the defense did not know about this at the time of admission to the hospital. Objection due to hearsay. It’s coming in.

3031 Dr Mendez’ records – He’s testifying, this particular exhibit was around the time of her trip to Mexico. It’s 39 pages of his records. No objection to the documents, except they want part of the record redacted that refers to Munchausen by proxy as being one of his possible diagnoses. Judge says this seems like something that could be cross examined on. Plaintiff continues on it maybe being a case of a doctor that does or does not like Maya Kowokski (this is a theme that the plaintiff is droning on, that all these 49 doctors who worked for different hospitals, different clinics, in different cities and even in different states all got together due to some “dislike” of Maya to claim that at least some of the basis of her pain was due to psychological issues of various kinds). Defense - this goes to confirm he is an independent treating doctor who suspected that there could be something psychological underlying. He saw irregularities, he made the same observations. The plaintiff has made multiple mentions of Munchausen by proxy, the jury has heard directly from the Kowolski's that they were floored by this, it took them off guard, they were offended, this is one of many prior physicians or hospitals that same to the same conclusions about possible MBP. (The jury cannot possibly unhear what the plaintiff's have put on about this, IMO it will be unfair to leave this out). Judge is asking if it's going to be used today. He needs to think about it more. Obviously there has been discussion of it. How does that talk to us about what JHACH should or could have done about the treatment of Maya Kowolski? (Just look at the questions the jury has asked, for JHC). Defense says the plaintiff has made in front of the jury that this was outside of standard of care, unfair, etc. Judge still needs more time. Defense says this also goes to Dr Wassenaur (the family's primary care physician). This is yet another doctor that talked to the Kowolski's about perhaps they did not need to go to Mexico, etc.

I want to state here that in the beginning of my treatment with the doctor that finally started me down the road of getting relief for my pain, he REQUIRED ME to see a psychiatrist. He required me to allow him full access to the records of the psychiatrist and required me to see the psych of HIS choice. I complied with every bit of it. If you really do have pain or a part of your pain is not due to psychological issues, there should not be a worry that a board certified psychiatrist won’t be able to figure that out. And truthfully, if you really do want to be pain free, you should be fully open to WHATEVER the cause of the pain is, so it can be effectively treated. Even with my pain management doctor requiring me to submit to psychiatric treatment it was determined that my pain did, in fact, have a physiological source and I was able to get the proper treatment and eventually a full diagnosis and explanation of what in the Sam Hill fuck happened to me. The psychiatric treatment did not interfere with that and it convinced my doctor further that treating with medical intervention was necessary.

Also, I was reminded today of reason number 616 (I may be slightly exaggerating) of why I believe Maya had pain but not CRPS pain. After her mother’s research is when the mother (not Maya) began describing the pain differently. But, the mother gave the daughter sufficient information about “her condition” that she then started a new thing which iwas not allowing anyone to touch any part of her body because she was too sensitive. I have that very symptom. It is limited to the front and back of the leg that I have the pain issue with. Maya’s description of it is that she can’t be touched at all for any reason for any length of time. The condition is called allodynia. During times when my leg is not being touched the burning pain is always there, but the allodynia is not. It is only upon touch. When the touch stops, the allodynia pain stops. I am unable to sit in a chair properly for any length of time. Because when you sit in a chair, part of the leg is touching the chair. If people are around, I try to sit as normally as possible and try not to make it obvious that I am putting as much weight as possible on my right leg because the part of the left leg that is touching the chair is screaming. Sitting through a 20 to 30 minute meeting you will notice me squirming, changing positions, crossing my left leg over my right leg so I can sort of lean to the right to as much as possible my left leg is not touching the chair. It is excruciating for me to sit normally. When my cat comes over and tries to put her paws up on top of my left leg I have to move her off, I just can’t take it. But in spite of Maya having this “all over” and she can’t be examined, she sits in a chair normally. All the video of her at the beginning when she was not being treated (i.e. the worst part of the experience) she looks perfectly comfortable sitting in a chair with all her weight normally distributed on both legs, which supposedly have this allodynia. When her mom rubs her back it doesn’t hurt. But if a doctor or nurse tries to touch her in any way the screaming starts. No matter where on her body the exam is being done, stethoscope, blood pressure, anything. She even claims that fabric touching it (this is mentioned on web pages) hurts. But she has no trouble with the fabric of sheets, blankets, being on her legs. Testimony even revealed that would sit cross legged with her food tray on her leg while she ate. I couldn’t put a feather on my left leg without crawling the walls and pulling it off.

Exhibits continued
Defense brings up that a witness has been accused of lying about it being HER voice on the phone calls. The plaintiffs have singled out two people as the “bogey men” at the hospital. One is Cathi Bedy, the other is Dr Sally Smith (there is also a Dr Michelle Smith, whose testimony comes in the next posting I will make). Maya has told the jury that Cathi Bedy did a number of bad things to her including that she was the voice on the phone calls that interrupted and redirected conversation when the mother started to go into problem areas. I prior posts you will see where the real person who was on that call stated in no uncertain terms that it was HER voice. She also wrote an email dated on the date of the call where she documented that she had had to redirect Beata a couple of times during the phone call.


The judge had previously disallowed the email to come into evidence. But the defense is trying to get him to reconsider because a jury question came up where the questioner was quite accusatory towards the witness that said she was the one on the call. (Some members of the jury have become extensions of the plaintiff attorneys, asking questions in ways I have NEVER heard a jury do before in any trial I have ever watched where a jury is allowed to ask questions) The judge responded that they now have differing testimony about WHO had interrupted the phone call and they would have to use their own judgement. The email dated on the same day where the real person was relaying what happened on the call and that she had had to intervene and WHY she intervened could help clear that up., especially given the juror was so clearly antagonistic in the question to the witness due to her saying something different than what Maya said. It is a prior consistent statement therefore it is not hearsay.


The plaintiff says the previous discussion is being misrepresented. The defense says they don’t have to put in the entire email chain, just this section. There were attacks by both the plaintiff attorney that this was NOT Ms LaPorte and even statements by the jury that seemed antagonistic toward her. This confirms in real time that she followed up with Beata about the phone call, apologized for having to interrupted, explained why she had to interrupt (exactly as she stated on the witness stand) and told Beata that she really wanted her and Maya to be able to have quality conversations that were not at all interrupted. The judge is not going to allow this in. There is continued discussion. The defense says they can revisit tomorrow.


Exhibit on dental records. Dated 2015 – present. Relevance objection. Overruled. Defense gets this exhibit in.


3034, 15 pages. Relevance, hearsay objection. Objection overruled, it will be admitted

3035 – Nemours records. Judge asks for time period, Defense will come back tomorrow on this one, not needing it today.

3037 – 2016 records. Relevance objection, hearsay objection. How is this a 403 issue? Because it’s an ENT. Judge says this occurred during a CRPS episode (golly, not an “alleged” CRPS episode? I think the judge had a slight Freudian slip there. It’s relevant because it goes against that she was actually having pain) It’s relevant, coming in. I’m almost surprised. Defense continues arguing. The doctors at JH did not have these, so how does it come in for their state of mind for treatment. Judge says you can cross examine, but this is treatment during an exacerbation of CRPS so it’s coming in. Plaintiff wants to see each and every page to decide if they want to continue arguing. Judge overrules

3038 – Dated Oct 2015 – 2016 Pediatric Gastroenterology and (?) of Florida. Treated for abdominal pain, RSD, constipation. Mention of ketamine coma. Judge says things like this we seem to spend too much time about relevance. These are medical records during the time period etc. Coming in.

3039, last one – Judge is looking at the records himself to see the dates. Plaintiff says this seems to be duplicative. Judge says it’s a different facility. Coming in.

Judge says the days are going to get longer, they are going through exhibits. Need to get better about not fighting every single issues. We are going to finish this case if we have to come in on weekends. (he doesn’t say so, but this is all directed at the plaintiff. Mr Anderson is a HUGE time waster. Wait till my next post, this issue BLOWS UP BIGTIME! Stay tuned.)

I'm at work today but was reading comments on Reddit and people there really seem to be picking up on at one juror who has asked a number of snarky aggressive questions of witnesses and that the Judge has made a couple questionable decisions, like allowing additional time for plaintiff after they've wasted all their time. Seems like at least a coupled on the jury are falling hard for plaintiffs.

Tiredretiredlawyer wrote: ↑Thu Oct 19, 2023 3:50 pm

Sorry, It 's a really bad day with mom. I am able to listen to testimony for the most part but not type. And i need to replay it to get it written up properly. Almost done with first witness.

Maclilly wrote: ↑Thu Oct 19, 2023 4:13 pm I'm at work today but was reading comments on Reddit and people there really seem to be picking up on at one juror who has asked a number of snarky aggressive questions of witnesses and that the Judge has made a couple questionable decisions, like allowing additional time for plaintiff after they've wasted all their time. Seems like at least a coupled on the jury are falling hard for plaintiffs.

I agree with the impression of said reddit comments.

Yes, Mr Anderson is a supreme time waster. With one witness on Tuesday he badgered her for a serious long time about the same freaking thing after the judge agreed to give him an extra 4 hours (but he's giving the defense also an extra 4 hours) because Anderson wasted so much time and had very little left to cross examine further witnesses. The judge was absolutely FURIOUS with him for wasting all that time on Tuesday after he had relented and given them more time. That dressing down occurred in court with camera on and jurors sent home for the day. Major spanking.

Today it was an EPIC sidebar when Anderson once again wasted his available time. I think the judge is truly fed up with that idiot.

But boy, at least one juror is seriously on the plaintiff side and playing detective. I believe that person is also doing research, it's just so coincidental that the things commenters are saying are what the juror just happens to ping on.

Defense witness – Dr Michelle Smith (not to be confused with the “evil” Dr Sally Smith)

Critical Care Physician at JHACH. Very soft spoken.

She says that she is a Critical Care physician and that Dr Sally Smith is also a pediatrician, trained to treat children in a critical care situation. (LOL, the defense wants to make sure the jury knows this is not the same person they have heard all about how evil she is)

She gives her background. Schooled at Georgetown University Medical school. Board certified. She’s been at ACH since 2002. It became JHACH later

Her primary role is a critical care physician. She has presented on quality projects, cardiac, and other areas. She became involved in the care of Maya on Monday Oct 10th.

Putting up her notes. Part of official medical record of Maya K. She takes a quick look at it, is this a note regarding her taking over the care of Maya on Monday Oct 10th. It regards what she learned from the weekend team. Maya had been admitted on the previous Friday.

She would typically have already spoken to the weekend team on Sunday so that Monday morning she is prepared for all the patients and aware of the basics of their situation. There is another handoff on Monday morning as to what occurred overnight. So, she has all the weekend information and the overnight information. They have a team huddle with all team members, including nurses, pain management, etc. So, everyone is on the same page.

Her first interaction was on rounds. The nurse would also give an update specifically to this patient, vital signs, lab studies, anything to review. At this time she would also interact with the family if they were present. She wants to refer to her note about discussion with family., she’s referred to a page. She remember this, she met with the father in person and she mentions that overnight the family had talked about possibly being referred to Nemours for transfer. She told Mr K that she would reach out to Nemours. When spoke to one of the physicians at Nemours and they had been provided with information regarding treatment over the weekend and they indicated that Maya would not be a candidate to be transferred to their facility. They had discussed it with their pain team, and were declining transfer.

(Maya looks angry during this testimony. She has not been in the courtroom during defense testimony prior to today. Normally she sits there with a pouty, sad look on her face. Now her face appears to betray actual anger)

Dr Teppa Sanchez had begun the process of trying to transfer Maya to Nemours. She continued trying to assist a transfer in the afternoon after her rounds. She relayed to Mr K what she learned about Nemours and Maya not being a candidate at this time for transfer. She left a message for Beata, as she did not answer her phone. The treatment plan was brought together to start to wean Maya from the ketamine and other drugs she was on. She attempted to conduct an exam. Maya did not want to be examined, so it was a limited exam documented fully in her note.

To the transfer issue – She told Mr K that Nemours wanted Maya on an outpatient basis and weaned…. Objection. Sustained.

No other communication with the K’s on that date.

On the 11th she arrived at 7:30 AM, conducted rounds as described previously. She was able to speak to Mrs K. Beata was concerned that information was not appropriately provided to Nemours and there were facts missing and she wanted to directly speak with the physician at Nemours about transferring Maya. Mrs K expressed that she wanted an intrathecal infusion pump. Dr Smith organized a meeting to take place with Nemours and Mrs K and herself along with other members of JHACH team via phone. Dr Santana, Dr Torres, Mrs K, social worker attended

She explains what intrathecal pain pump is. It goes into the spinal chord. ACH doesn’t recommend it, literature of CRPS doesn’t….objection, sustained. She gets to say that she usually has used it on cancer patients that are terminal.

Re: telephone conference – Mrs K told her story and Dr Santana said she has a lot of experience with CRPS and she had an outpatient clinic and would accept Maya in that clinic. She indicated her treatments were very well accepted by CRPS patients, very successful and she would dbe happy to have Maya come as an outpatient tto that clinic. Dr Smith believed that everything was in place, the K’s were agreeable and her understanding was that this was going to happen. Beata expressed that she was interested in pursuing this.

Eventually she learned that Beata still wanted the intrathecal pump and she wanted to check with the Cleveland Clinic or “some other place” to see if she could get the treatment she wanted Maya to have. Dr Smith says she left it to Beata to determine exactly who she wanted to reach out to, and that Dr Smith was willing to try to assist in any way but was not going to call around to various places, Beata would need to indicate where she wanted Maya and Smith would help in any way she could.

Wednesday was the last day she ever worked with Maya. She met in the morning with the team, she reviewed the weaning plan with Beata K, who agreed at the time, they looked at the CT scan, they decided to do an endoscopy because of the abdominal pain that was still undiagnosed at the time.

The pain team continued being involved at tall times. They were keeping her pain under control. The weaning plan was gradual on the ketamine, 1 mg/kg per day, presidex (used in ICU as a sedative and analgesic), clonidine weaned to a patch with oral breakthrough until patch fully effective. Over this period. The wean was progressing normally, Dr Smith was not having to be called to the room for break through pain, it was well controlled. She never had any further contact with the K family after the 12th when she went off duty.

Did she ever hear from the K that they wanted to leave the hospital against medical advice? No not during those days.

Cross exam:

So, you were aware the K family was threatened to be arrested if they tried to leave.

No, she did hear on Monday morning that dhe K family had over the weekend wanted to leave AMA (against medical advice). Did you disagree with the diagnosis of Maya’s outside doctors? They had no CRPS program at the hospital. Beata seemed cooperative and knowledgeable. She was polite directly to Dr Smith during the three days Dr Smith was there. She did ask for therapies that were unusual, but she was polite to Dr Smith about it.

Was the hospital keeping her there because they believed Beata was a danger to Maya. She disagrees. She says up to that point they could have left except that she needed to be fully weaned off the medications, she needed to be stablilized as far as being able to drink liquids by herself. She was on signification doses of sedation and it was unsafe to leave at that moment. At that time the K family could have allowed her to finish weaning and they could have aken Maya out without any issue.

Thre had been red flags and some level of escalation had occurred but not to a point where the hospital would have kept her there against the family’s will.

If the child is under DCF shelter, then they have to call security if the family tried to take the child out. There was no hold at the time Dr Smith was involved, they could have taken her home once she was weaned. They had not resolved her abdominal pain or eating and drinking. The hospital would dhave recommended that she be stable before leaving.

She’s being badgered about the ketamine specifically. Dr Smith said this was not her primary concern it was he whole situation of her not being stablilized. Haloperiodol was recommended by the pain team with Beata’s agreement, he’s trying to say this doctor was trying to give her anti-psychotics.

Mr Anderson is an asshole and constantly trying to badger witnesses into agreeing to things they never said. This whole cross exam is full of that.

She explains that when a family says the child is diagnosed with a specific illness they don’t just automatically go through a complete history and re-diagnose. He’s trying to get her to say the hospital diagnosed her CRPS. She is not having it. It was provided by the family that she had been diagnosed with CRPS by a specialist. They don’t just go around and disbelieve a family.

Beata found out about the intrathecal pump from a CRPS chatroom. Dr Smith says she is not a pain specialist but she is aware that it can provide control of pain at lower doses of certain medications. She never had anyone ever ask her for one of those before.

He’s trying to ask her about the diagnosis code on Nemours paperwork. It’s already been established that Dr Smith was not involved in any further business with Nemours. The last she knew was that Beata had agreed to an outpatient transfer to Nemours. She’s aware that CRPS is the most painful condition known. Why not just let them go? She never asked me if she could leave. She says she would have said she’s not yet ready for discharged, but if she had been safe to discharge (weaned and stable) she would have discharged her without any argument and she would have been obligated to tell DCF about the discharge because they were already involved by that point in time. There was no shelter order in place so Maya could have been removed, but they are required to notify DCF if DCF had any involvement with the situation at any level, which they did at that point.

At this point you have not done an extensive review of Maya’s records? Dr Teppa did a thorough review as the admitting physician. There were medications that the pain team had recommended under an as needed basis. She was not aware of anything about outside pain management but the family was involved in all of the in house pain management team. She gives the name Dr Elliot and his Nurse Practitioner (whose name she can’t remember, he has a different one now).

Usually one pain management is working at any given day. Sustained objection on Mr Anderson being argumentative. Now he’s asking “on that little team YOU put together who was on that team”? What an ass hole. She says yet again, for about the third time – Dr Elliot makes the pain care decisions as the pain specialist on the team those three days. Beata was cooperative about the plan of care. She did ask for things that Dr Smith did not believe were indicated, and they would have discussions about that.

He’s saying she has multiple patients that ask for certain treatments that the doctor doesn’t agree with, but that wouldn’t be reason to keep her there. At this point the judge breaks in and says “may I see the attorney’s please”? Mr Anderson has been spending a huge amount of time trying to insinuate that this doctor was responsible for Maya being kept at the hospital against the family’s will. They have a count that this goes to and that’s one of the big money payouts. But this doctor has MULTIPLE times said she worked the ICU during 3 of the days that Maya was there, there was no shelter order, she was NOT being kept against her will, she would have discharged her in a heartbeat the MOMENT she was weaned and stable.

The judge is PISSED off, he is reaming Mr Anderson. He is trying to pretend that he’s talking to all the lawyers by lowering his head, but with the camera angle you can see that he’s mostly looking at Mr Anderson and his face is showing that he’s had enough. Mr Anderson is getting a major spanking from this judge. At some point he doesn’t even try to look like he’s talking to anyone besides Mr Anderson.

When they break up Mr Anderson is finished with his questioning. Judge tell the jury to disregard the last question that was asked. No more questions.

Brief redirect –

No CRPS program at the hospital. Transfer to Nemours was because the family requested it and that Nemours did have a CRPS program.

May looks absolutely deflated after this testimony.

Jury questions
1. As the treating physician in the PICU what diagnosis what where you treating her for? An acute pain exacerbation and she was being evaluated by appropriate medical staff for reported abdominal pain.
2. We have seen her admitting and discharge diagnosis as conversion or factitious disorder, what was the diagnosis you were treating her for? I was only involved in her care for a three day period, we were treating her for an acute pain exacerbation and abdominal pain under a reported diagnosis of CRPS
3. If you meet as a team to hear about the weekend, would the weekend team have told you that she was considering leaving AMA? Yes, that would have been discussed with me during any hand-off
4. How much IV hydration was she receiving at that time in the PICU? I don’t know the exactl amount as I sit here, but it would have been a normal maintenance amount according to whatever she was eating or drinking on her own at that time.
5. Was Maya taking any oral intake in the PICU? I think she was drinking a small amount but not eating
6. Was she showing any signs of withdrawal of ketamine during that time? She was weaned off it by Wednesday morning, so I would only have been involved with her for a few hours once she was off it. (I wish she would have made a point that that is the whole point of weaning – to slowly get the drugs out of her system so she wouldn’t go through withdrawal all at once)
7. You referred to ketamine as being psychotropic. This to my knowledge and according to previous testimony is the first time anyone has used the words ketamine and psychotropic in the same sentence. Is ketamine a medical diagnosis prescription listed as a psychotropic drug or only other side effects could be brain fog or hallucinations? (oh, lordy, that same juror that has asked other awkward questions ). Ketamine is a dissociative agent and that is how we usually talk about it, it is used for anesthesia and when I use it I am typically using it for sedation. I’m not sure if that exactly addressed that question
Defense follow-up
1. You were taking care of this patient from Oct 10-12, 2016? Yes
2. Only tranfer effort made was to Nemours? Yes
3. And the only diagnosis at the time was CRPS? Yes
4. Did you have an understanding of why the family didn’t want to transfer at that time? Nemours didn’t accept the transfer as an inpatient, but were willing to take her as an outpatient.
5. Did you ever have an understanding as to why the family did not wish to transfer her to their outpatient program? Mom wanted to go somewhere they could get an intrathecal pump and that was not part of their outpatient program. Objection, hearsay. Overruled
6. You were asked questions about the extent to which Maya was getting IV fluid. I’m going to ask exhibit #(?) and there is a section there, does that indicate the amount? Yes, we track everything that goes in through their mouth or through an IV and everything that comes out. So, we track all fluid and food intake.
7. Was the patient at the time, had she been placed on TPN? Mom asked that she be placed on TPN which is a nutritional mixture. Usually we prefer to allow the patient to use their own GI-tract, especially for short term situations, and because we would not be able to discharge her with TPN for outpatient use. Mom indicated that she had someone that would prescribe TPN for her outpatient, so we agree to forego the gastric tube and we placed her short term on TPN. (The family claims that they tried to force a gastric tube through her nose and into her stomach, but it sounds like this is not the case. The hospital originally ordered it, it was acknowledged in the system, but there is no evidence provided so far that anyone actually did it, as Beata apparently got Dr Smith to agree to the TPN)
Plaintiff – no questions.

Defense witness – Dr Beatrice Teppa Sanchez
Critical Care Physician at ACH, started at ACH in 2016. Went to medical school in Venezuela, passed all requirements to do residency in the USA. Did residency in Texas. Accepted at Emory U for residency in Pediatric critical care

Board certified in Pediatrics and Pediatric Critical Care, includes initial testing and CEUs

She brought her notes for her care of Maya K. She has all three days of notes.

On the day of admission to ICU on the 7th in the afternoon. She understands that she was treated in Emergency room but then was transferred to PICU around 4 PM that day. Usually 2 critical care physicians on the whole critical care ward, 2 teams, and Maya was assigned to her team. She had never met or heard or had any contact with the K family up to that point.

When she first encountered them she came to the room upon their arrival. There was a huge amount of screaming by Beata at that time arguing with nurses as they were trying to put monitoring on her as they do with all patients. It was loud and chaotic, she initially tried to calm things down. There was screaming from Maya herself as well as her mother.

The concern was that Maya was in pain and everything that was being done Maya specifically said “I need my anesthetic medications”. Dr Sanchez specifically remembers those words and noted them because of how unusual it was for a 10 year old to talk this way and ask for “my anesthetic medications”. Mom was telling the nurses “you don’t know how to treat my daughter, listen to me”. Eventually she was able to get things calmed down, she wanted to at least try to get minimal amount of information to try to get interventions started.

They gave her benzodiazepine in order to calm Maya down. It’s a sedative. At that time she knew the ER did lab work, the family brought her for abdominal pain, Dr Sanchez discussed that we needed some kind of imaging for the abdominal pain. While honoring all her history we want to figure out what is going on. The things that stuck out to Dr Sanchez about Maya’s behavior was she couldn’t ever give any details about her pain, but just said “I hurt” but then she could use medical terms like “I need you to push (inject) my medication” or “I need my anesthetic medication” and other strange wording for a 10 year old. She would name several medications that she wanted, but still never said what part of her body hurt. Dr Sanchez said she felt the girl was clearly suffering in some way, and she was trying to get her help.

Dr Jenny Dolan was the pain specialist that worked the three days that Dr Sanchez worked. Maya just kept saying she was “hurting”. The only thing the nurses were trying to do at the time were to put the monitoring stickers on her chest and Maya was screaming about that. Mom could rub her back and that didn’t hurt. Maya could never specify exactly what was hurting, it wasn’t terribly clear what was causing her the most pain.

She got a history from the mother once they finally calmed down a bit. She took Mom to the couch to try to “bond” with her and get Beata to open up and understand that Dr Sanchez wanted to help with anything they needed. Went through the prior year of history. Dr Sanchez had not been able to directly talk to anyone in the ER.

She received info about the pain meds given in the ER. She had been given some ketamine and benzo’s. The pain team started a ketamine at 3 mg/kg per hour and then some meds PRN. Propofol was given at night only so she could sleep. An abdominal CT scan was on the plan, but the family would not allow it unless they sedated Maya with the amount that Beata wanted. The study eventually was completed, but not right away because of Beata’s demand for a huge dose of ketamine before she approved of the abdominal scan.

The plan was to stabilize Maya and get her suffering under control. At some point to get the CT scan. Beata told Dr Sanchez about the kind of medications she was receiving from Kirkpatrick and Hanna. She told her of the amount of doses she was getting. She also told her about the ketamine coma. Beata also told Dr Sanchez that she “needed to intubate Maya and give her the same kind of 4 day ketamine coma” she had received in Mexico because that was the only thing that would take her pain away.

Beata mentioned that she went to Lurie’s, but she did not tell Dr Sanchez what the diagnosis was. She also said she went to Tampa General and did not give details about that either. She said the diagnosis was CRPS but it was in her entire body instead of just a limb. She also told Sanchez about the asthma. The pain team was doing all the recommendations for all the pain treatment. She deferred to them for all of that (just like Dr Smith said)

Beata expressed that she was super stressed. Dr Sanchez told her that she would make sure psychiatric was also involved because regardless of what is the source of pain, there is always a psychiatric component whether it’s part of the cause of pain or the result of pain. Beata refused for any psychiatric involvement, so none was done. Dr Sanchez said she believes at one point the psychiatrist did stop in, but Beata refused it.

What was the diagnosis upon admission to the PICU. She explains that there are two sections, a history and a section for current. The history was CRPS and the current was acute generalized pain exacerbation and abdominal pain.

Looking at your note, can you explain this section? Yes, this is what her history was, medication, prior diagnosis, developmental history, review of systems, labs, imaging studies, and assessment, and plan.

Showing and publishing 1001-31 – 38 exhibit to be put up. ACH chart. Scroll to plan portion. The plan for the patient was to closely monitor, pain consult and continued pain management, specific medications, at least three days of treatment to get the pain under control, this was all explained to the family. If she required higher doses that we expressed to the family that there is a risk of cardiac failure and intubation. They wanted to pursue psychiatric, Beata agreed, but once the physician came she denied it. IV Fluids were given, nausea meds, monitor constipation, abdominal CT, urinalysis, SCDs (compression devices to prevent clots).

Before formulating the plan, Dr Sanches looked at all records from all previous visits to JHACH. There was a huge amount of documentation, Maya had been there quite a bit. She went through all the prior ER visits, notes from consultations, pulmonologists. Beata initially demanded very large doses of medications, Dr Sanchez wasn’t comfortable with it and told her she was deferring to pain specialists on the team, there were back and forth at every step of the way with Beata agreeing then disagreeing. Beata was demanding more than 3 times what pain specialist at the hospital were comfortable with.

At some point Dr Sanchez sat down with Beata and Beata told her she had been very stressed and that at times she felt like she couldn’t do it any more. Her and Maya were very stressed. At times Beata “wanted to die” and at times Maya told her “I want to go to heaven”. Dr Sanchez was concerned and once again tried to gently guide her to at least talk to someone about it. Then Beata said something about right now I don’t feel that way. Dr Sanchez inquired about her support system, Beata said she had an excellent support system. Dr Sanchez documented it all in her notes, but didn’t push further because when Beata said she doesn’t feel that way right now there really isn’t legitimate reason to pursue. Beata was not her patient. She once again tried to get Beata to allow some counseling for Maya, but Beata declined. Dr Sanchez said if you ever find in the future that you start feeling overwhelmed I would be happy to help get you resources.

Dr Sanchez wanted to have a consistent plan for treatment so they make sure the night shift is informed. She usually leaves the hospital around 5 or 5:30, but because of all the issues with Maya and Beata, she didn’t leave until 8 PM.

On Saturday there were new developments. After reviewing notes from the night staff she had questions about the home therapies. Beata was doing home infusions and IV’s and Dr Sanchez had questions about that. (Sidebar)

(Something happened on Saturday that the plaintiff does NOT want into evidence There is a long sidebar)

Saturday and Sunday it was mostly Mr K that was there in person. Dr Sanchez had phone conversation with Beata. (I am super curious as to why. I have a feeling she may have been asked to leave at that time_

On Sunday a new plan went into effect. They were going to wean Maya from the medications. Maya was not in the same state on Saturday and Sunday and that was according to her father. (This is a pattern of Maya being better when Beata was not around) On Sunday Dr Sanchez became aware the family wanted to move Maya to Nemours. Dr Sanchez began the process of trying to arrange a transfer, but on weekends she can’t reach a physician. She was able to reach the transfer center so they would at least be aware that there would be additional contact about it on Monday.

She handed over treatment to Dr Michelle Smith who was taking over on Monday morning. She signed off to the night doctor for the overnight shift. (sidebar)

During the weekend was the working diagnosis CRPS? Yes
Also concern about abdominal pain and “all over” pain? Yes

The protocol that was being used, did you and the pain team discuss it with the parents? Yes
Did they agree to what was being done? Yes

After Oct 9 any further contact with the K family or Maya or her care? No

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No questions from plaintiff (laughing my ass off here. He’s smarting from those two huge spankings. I guess the judge probably told him he’s not getting any more additional time. I think when he went on to waste time in a huge way TWICE after the judge gave him more time, the judge probably tore him a new hole)

Jury questions:

(OMG, I think the witness that had been so defensive is in the audience today. I can’t tell for sure. She’s a serious sourpuss, she came across awful. If the jury sees her in the courtroom, that will NOT be a good look)

1. In your testimony you mentioned Beata wanted to “die”, who made these statements, were they said in the same interview or at different times? Beata made the statement about wanting to die about herself. She made the statement about wanting to “go to heaven” about Maya. All in same conversation when we sat on the couch. They are clearly stated in the medical record notes.
2. They are in evidence, yes
3. What date did you communicate with Dr Sally smith? On Saturday, the 8th (that explains the plaintiff shutting down questioning about Saturday, I guess). She spoke to her after morning rounds after seeing all the patients.
4. What documentation of this contact. It was a phone communication
5. How long did Maya spend in the ER before PICU? She doesn’t know
6. When Maya transferred from ER to PICU was it calm? No, it was very chaotic, words that I woun’t say here. Very aggressive at some point
7. Did you discuss with Dr Michelle Smith that the family wanted to leave AMA? No, because up to that point it was never brought up. There was talk about transfer to Nemours, but I was never told they wanted to leave the hospital outside a transfer to Nemours
8. Why was the family not allowed to leave AMA? (There is no evidence of that at this point, I’m surprised the judge allowed this question). I don’t know because I wasn’t there at any time involving AMA.
9. Isn’t it protocol to chart in your charting at the end of your charting the discussion with family and parents? Yes, it’s on my progress note on the 9th, we sat with Mr K in person, Mrs K was on the phone. It’s all recorded in my notes.
10. Did you report about the “want to die” and “heaven” comments to anyone to see if she needed to be held on a psych hold? I definitely consulted with psychiatry that we have at ACH for Maya, but for Beata, she wasn’t my patient (it’s a children’s hospital) and Beata said she had not recently had these thoughts. A psych hold is for someone at risk at the time not for some unidentified time in the past. She did encourage Beata to make sure she contacted us or someone if she ever felt overwhelmed again.
11. Could you not contact security if you had concern that Beata was going to harm herself? At that point I would have probably contacted our social worker to find out what the procedure would have been if I had had concerns that she was going to harm herself. I would have had to have sought guidance on that if I had a concern at this time. Beata had assured me she had family support , a very good friend and family support system and that these feelings were all in the past.
12. Did the ER doctor mention to you or the admitting doctor her concerns about child abuse that she talked about in her testimony (somewhat misstating the evidence. She had testified that she had some concern as part of her differential diagnosis, but this is the kind of thing that has to be investigated on many levels and not something for an ER doctor by herself to determine. Unfortunately Dr Behar Posey passed away, that is why her testimony was deposition. I had not realized that at the time.)
13. I missed the exact question, but it has to do with the doses of ketamine given. Dr Sanchez reads from her notes “Mom states that at this time Maya needs to be placed into an induced medical coma using ketamine”. Then she reads from her plan – “I just state the final dose of what we agreed on to give to Maya”. These records are in evidence says the judge
14. Was Maya dehydrated prior to arrival? By the time I saw her, she was already receiving IV from the ER, so I did not see extreme dehydration by the time she was in the PICU
15. A question about her weight and malnutrition – I did see that my initial impression was that she was extremely thin. I documented that she needed a nutritional evaluation.
16. Please describe SCD for prevention of blood clotting. Most of our patients get SCD to prevent blood clots because they are bed bound. They are less invasive than medication. Patients usually like them because they are like a massage. (Maya says she can’t be touched)
17. Your administration of ketamine seems like methodically and incrementally moved up. Is this normal? We start with a low dose and see how the patient is responding. It went up slightly over the weekend, but not much.
Defense
1. Over night it went up slightly. How long was that in place? It stayed at that level for Saturday and Sunday
2. Did you have an understanding it would dbe weaned down? Yes
3. Why was that the max? That is actually higher than we were comfortable with, so we wanted to lower it as soon as we could
4. SCD’s – Why ws that necessary? You have a scale for risk because she in bed, she hadn’t been walking, she’s sedated, had a central line, she’s at risk for clotting.
5. Mention of the exchange for “suicide” Can you elaborate? She reiterates that family, friends, church are all available and she said her thoughts of wanting to die were all in the past so at that moment I did not have a concern that she would commit suicide. She was very believable when she said it wasn’t a present thought of hers.
6. There was a question about the patient and family behavior at PICU. You mentioned some aggressive speech. What were you talking about. (She seems reluctant to say this, she’s avoided it throughout the testimony) Maya was cursing directly at her, said “f…you b….” and spit on Dr Sanchez, cursing and spitting at the nurses as well. (Sanchez is trying to make excuses for Maya’s behavior, doesn’t seem comfortable with having to directly say this, mentions she’s a child, etc)
Plaintiff
Sarcastically asks her it must have been really something with a 10 year old dropping an F-bomb. She agrees it was highly unusual, had never happened to her before.

Asks her why it’s not in her notes. She says the notes are so that the staff will all be aware of this. All the staff was in the room , so they all witnessed it, no need to put these in her permanent medical record. She doesn’t put curse words in her records at any rate. She did put there was “aggressive language” in her notes, but didn’t feel the need to be specific. Now he continues to challenge her so she’s looking for her notes so she can read what she wrote. She points out where it is then reads the whole thing. “Very aggressive with staff” is what she wrote in the notes as a summary. He asks if it’s “offensive to you”. She says yes, it is. (This lawyer is an asshole, this doctor clearly didn’t even want to say this in front of the jury)

They bring up a text message where Cathi Bedy had texted to her after Beata’s suicide. It was initiated by Cathi Bedy, not by Dr Sanchez. Cathy Bedy texted to Dr Sanchez personal phone. Cathi Bedy’s messages are not very professional, but Dr Sanchez expresses how sad that is. She also says that is “f…d up.” So the lawyer is making a big deal that she says she’s offended by that language. Maya had used the actual word sand directed them toward nurses and Dr Sanchez. Dr Sachez was not saying “f you” to someone she was saying a situation was “f….d up.” She didn’t even type the whole word, she typed just what I just typed.

OMG. He asks her “isn’t it true you testified that you don’t have any remorse for any of this?”. She is stunned and starts to say “of course not”. The judge calls the lawyers to come up to the bench without even waiting for the defense to object. Dr Sanchez really looks upset while the lawyers are at the bench.

The jury is to disregard the question.

“You seem to be OK with texting the “f” word”. She says “to a friend” and points out that she didn’t even feel comfortable with a friend typing the whole word.

She was in pediatrics for about 4 years and pediatric critical care she had three years of fellowship before starting at ACH.

The text messages were from private phone? Es
As opposed to your medical record? Yes
Where those three years after you had last seen this patient? Yes (she had not known about Beata’s suicide prior to this)

More jury questions
1. Is it normal between employees at ACH to refer to patients as “ketamine girl” or other nicknames? She answers that they can’t use identifying information. The other person has to be able to know who you are talking about, so something that tell the person “who” you are talking about has to be made, but there can’t be any identifying information if the communication is on personal phones or email.
2. Did you notice any dystonia in Maya’s feet? I don’t recall seeing any dystonia, there was a lot of movement in her legs. There may have been some inward turning of her feet, but I wasn’t able to do a full examination of her during those three days.
3. Are you the one that said “learned today” on the text message? No, I received that text.
4. You said that once Maya left your care you had no further contact, but it appears that you were keeping up via text message on patient Maya. No, I took care of her until the 9th. No, I’m the one in blue, there is nothing indicating that I was seeing her. I received that text message, I did not initiate it.

My common practice is that I do not use a patient name on outside communication.
Do you know Dr Dees? I do.
Judge shuts down Mr Anderson, he’s trying to ask this witness about an email or something that she was not ever a recipient or subject of that email.

JHC.

RV- I didn’t mean to pressure you!! Your posts are so well done I wanted to convey how interesting they are! Your mom’s care comes first, of course. Mea culpa!