Taking Care of Maya - FL CPS/Munchausen case

[Suranis]

My sympathy is tempered by knowing Her Dad and this girl are trying to extract 220 million dollars from a hospital that helped break her out of an abusive medical regime which could have crippled her development and messed up the rest of her life. The bastards.

[pipistrelle]

My sympathy is tempered by knowing Her Dad and this girl are trying to extract 220 million dollars from a hospital that helped brake out out of an abusive medical regime which could have crippled her development and messed up the rest of her life. The bastards.

Yep. And if she’s as smart as positioned she knows what she’s doing. And sees $$$.

[Sam the Centipede]

Fair points, Maya is indeed a plaintiff in this attempt at extortion. Perhaps she is motivated by dreams of a mountain of gold. Many would be.

But I cannot imagine what it must be like inside Maya's head after that upbringing. Many victims of abusive cults struggle deeply long after escaping their cages. But Maya has not yet escaped, far from it – as had been pointed out, her father was and still is a serial suer. And she lost her mother to suicide, which must leave deep mental wounds.

As the French say: tout comprendre c'est tout pardonner, to understand fully is to forgive fully.

Maya should behave better now. But realistically, what can one expect?

[RVInit]

Fair points, Maya is indeed a plaintiff in this attempt at extortion. Perhaps she is motivated by dreams of a mountain of gold. Many would be.

But I cannot imagine what it must be like inside Maya's head after that upbringing. Many victims of abusive cults struggle deeply long after escaping their cages. But Maya has not yet escaped, far from it – as had been pointed out, her father was and still is a serial suer. And she lost her mother to suicide, which must leave deep mental wounds.

As the French say: tout comprendre c'est tout pardonner, to understand fully is to forgive fully.

Maya should behave better now. But realistically, what can one expect?

I do see your points. I think I'm kind of in between here. Yes, she has been brainwashed to a very large extent. She was told by doctors and her mother that she had CRPS. And likely not finding any really good information about how it actually progresses. Anything you likely find online just says here is the list once you have it, not a good description of the progression of it. Which is one of many things that made it easy for me to see that she doesn't.

I'm sure that all she has heard over the years from her support system is how bad the hospital is and how they lied to her. And the attorneys have made sure that she is not in the courtroom for any of the nurses testimony. Those are the ones who spent time with her, playing with her, making bracelets with her, taking her to the activity center, catering to her eevery need, praying with her, picking up Shopkins and paying with their own money to add to her collections. They even made her a special guest of honor at their staff Christmas party which they had never done for a child before or since. She was treated like a little princess the whole time she was in that hospital.

And I will grant you that her family and now her lawyers are making sure she is not exposed in court to any reminder that she was treated so well at that hospital. Her nastiness on the witness stand toward the hospital staff was sickening to me. Especially after hearing how much they went out of their way to treat her like a special person.

So, yeah, I'm a little torn on how to feel about Maya. But seeing all these photos of her out on the town clearly having fun, dressed quite immodestly, attending a film festival in New York, bragging about all the college offers she has when she was first on the stand, and then crying that she probably won't be able to attend college because of her on again off again pain. I don't know. I definitely don't have the same disdain for her as I do for the father who stood by while his wife shopped around for diagnoses for very serious conditions, and then allowed her to get these serious treatments that clearly made her worse. Maya was definitely victimized as a child. And I guess now it could be said she's being further victimized by her support system shielding her from truthful testimony about her stay in the hospital and encouraging her to believe her stay in the hospital was one tortured day after another when there is clear evidence she was having the time of her life as the center of attention while she was in that hospital.

So, definitely not as bad as Dad, but she is old enough to at least question why she's clearly being told to leave the room when the people who saw her day in day out and spent the most time with her are on the witness stand. And yesterday when she got angry about those pictures, the sweet little modest girl gave way to a sneering seething something going on underneath that veneer she is putting on for the jury. She knows that she is living the life of a normal teenager and clearly knows she's lying about that at least. And I have no problem with the quite immodest dresses and Halloween costume but to sit on that witness stand and pretend she is so modest that showing her bare midriff gave her PTSD is over the top lying when at the same hospital stay she wore a revealing costume for Halloween at the hospital at age 10.

(She also shaved her legs, wore makeup at age 10 at the hospital. Which seems a little young to me, but maybe things are different today than when I was that age.)

[Sam the Centipede]

I agree about the dishonesty: Maya is old enough to know better. And that concerns both her lying about the staff and avoiding them in court and her two-facedness about modesty.

But, donning the tout comprendre hat again, what can one realistically expect after that upbringing and the normalization of lying to satisfy a desire, be it money, attention or more drugs to inflict on one's daughter?

We don't expect the Trump offspring to behave in a non-Trump way, even though they are definitely old enough to know better. Those rotten apples fell close to the orange tree.

So I don't exactly feel sympathetic towards Maya, rather I'm thinking "what can you reasonably expect?" And I certainly hope the family get a resounding "NO!!" verdict.

I hope Maya matures to be a better person than her parents. But too often the young abused in a family grow up to be the older abusers, which is both ironic and tragic.

[RVInit]

Yes, that is true, I definitely see your point about the "training" she's getting from her family and that it plays a huge part in her current attitude that lying is OK to get what you want. It is definitely learned behavior and probably a great deal of it not her fault.

[RVInit]

No testimony today. The testimony was halted briefly so that the plaintiff can get something bad about the hospital in front of the jury. It's a nothingburger that can easily be blown out of proportion to a jury. I will put that in the next post.

Since we had unexpected stoppage in the rebuttal case, they decided to use today to go over the jury instructions. I think basically sounds like the instructions are pretty fair, but I wasn't able to listen to every part of it. What I did hear sounds fair. Mr Anderson, the plaintiff attorney still thinks he has more unlimited time to wait until next week and wanted to hem and haw over the instructions and the judge at one point told him today is the day we take a very sharp pencil to the instructions. He is a nincompoop for sure.

[RVInit]

The nothingburger that probably will win millions for the plaintiff:

The JH All Children's Hospital is located here: 501 6th Ave S, St. Petersburg, FL 33701

The JH Heart and Vascular Institute is located here: 601 5th St S, St. Petersburg, FL 33701

They are entirely different buildings, entirely different staff, one is for children and one is for adults. Maya was in JHACH, the first one, the children's hospital.

The Children's Hospital has passed all accreditation every three years since forever. And so did the Heart and Lung Institute. But, the Heart and Lung institute apparently self reported an issue one month after the 2018 accreditation period, which the accreditation team came in August 2018. The self report resulted in the Heart and Lung Institute having an "IJ" put on their record for a one month period until the hospital could show they made changes, those changes were accepted, and a reinspection cleared everything up. And apparently the CEO at the Heart and lung Institute lost his job over it. So, they are trying to claim this was a systemic issue that affected the entire Johns Hopkins operation. Which, so far it doesn't sound like that to me.

The defense brought in their accreditation report that was done in August 2018, they brought in the report having to do with the IJ, and several reports surrounding the IJ and the final report clearing the Heart Institute.



JHACH is accredited every three years. it is a serious undertaking involving dozens of investigators that go through that hospital with a fine tooth comb. Which is why the plaintiff wants to make a big deal out of an issue with the Heart and lung Institute. Because the ACH defense now had to provide all the reports for all accreditation for the CHILDREN'S HOSPITAL to the court since 2012. And each three year report is hundreds of pages and will include things like "one of the janitorial closet was found to have a bottle of chemical when it was supposed to only have the brooms and mops" and all kinds of other stupid shit that of course any inspection like this will reveal. There are likely to be a dozen stupid shit that the defense can use this issue of the Heart Institute, a separate building with different doctors and nurses down the street from the Children's Hospital.

So, the judge is playing right along with the defense and requiring every single accreditation for the Children's Hospital since 2012 to be brought in and given to the plaintiff. I can see this blowing everything up.

[RVInit]

I did some research about the JH Heart and Vascular issue and it appears that it had to do with a total of 6 babies that died after heart transplant, apparently they were all "blue babies".

I found national survival rates for infant heart transplant for blue baby syndrome.

97% survive 30 days

91% survive one year

87% survive 3 years

Apparently the parents of a blue baby that did not survive sued the hospital and the hospital settled for $2.3 millions, which is not that high

Then, the family went to the newspaper and the next thing you know 5 other families whose infants died at some point after the surgery sued the hospital after reading about the family that got $2.3 millions, so they all got their settlements as well.

I couldn't get details of the time period the infants survived before dying or if they died during surgery or what. I think that would be very helpful in analyzing this thing.

The hospital did throw the CEO under the bus, firing him as part of their "case plan" to clear up the IJ. Given the IJ was cleared up within 30 days makes it hard for me to believe this was a truly systemic issue that should have anything to do with Maya's 3 month stay in a building with different doctors, surgeons, nurses, physical therapists, psychologists, and other staff.

I tried to find information to see if JH Heart and Vascular Institute had lower than national statistics outcomes for these blue baby surgeries, but couldn't find their statistics. Interestingly, it was one of their own surgeons in 1944 that developed the blue baby transplant surgery procedure and Johns Hopkins back in 2008 were fighting against the government lowering the standards for certifying hospitals to do these surgeries and now they are being accused of having "systemic issues" by the plaintiff in regard to this blue baby thing. The truth is probably somewhere in between, wish I had more information about survival rates.

But $2.3 million settlements for infants that died after(?) transplant doesn't seem like the families thought they had a huge case against the hospital. But who knows for sure, I don't at this point.

[RVInit]

I finally found an article about the issues at the Heart Institute that was not behind a paywall. Wow. Eye opening. But, it wasn't what I would call exactly "systemic" throughout the whole of their Children's hospital units.

It was within this one unit after a Johns Hopkins employee was put over the Heart Institute and he brought in two questionable surgeons and instead of the existing surgeon who had a stellar reputation and stellar results doing all of the complicated surgeries, they split them between these three surgeons. And all of the issues were related to the two new surgeons.

If you read this, I recommend reading all the way through because it sounds super bad until you get to the crux of it, then it's clear it was a small group of three or four, who were all canned. The surgeon who had previously done all the surgeries with exceptional results was demoted after he reported problems, then he left.

But now he's back and actually in charge of the Heart Institute.

https://projects.tampabay.com/projects/ ... institute/

Edit: The judge originally said if this is restricted to just the Heart Institute that he will not let it in. but if it is systemic that is a different story. As far as I have been able to find, there has been no allegations of issues outside this Heart Institute, and, the Heart Institute had excellent outcomes when Dr Quintessenza was there. He left for only three years and was brought back as co-director of the Heart Institute once the issues were brought into the open and the CEO and the two sub par surgeons were given the boot.

Unless the judge changes his mind about the "systemic" thing and sticks to his word that he will not let this in if it was only the Heart Institute, then this should not become an issue in this trial. Or, if there were issues in the unit that Maya was in during that same time frame. As far as I can see, the Heart and Vascular Institute has their own management aside from All Childrens main unit where Maya was.

[RVInit]

Yesterday they worked on finalizing the jury instructions. All in all I think the instructions are fair, there were a thing or two that may make things difficult for the defense on some of the counts, but I think the judge seemed to be trying to make things fair.

There is one count that i am just shaking my head on and that is this crazy false billing. I really think the defense needed to bring in a coder to tell the jury outright that if doctors had taken the CRPS diagnosis completely off her records, every single thing they billed for would still have been approved and paid. And that is because when services entered, the system will determined if that service is justified based on the existing diagnosis list. There is literally no service that was rendered for that child that was only restricted to the CRPS diagnosis. Based on how this was presented to the jury I'm not convinced that six jurors will be able to understand this.

And I am basing that on how the general public is reacting and believing "the hospital billed for CRPS". That way of looking at it just seems to be the prevailing belief. I understood that they are billing for services, the system is looking at the diagnosis list to see....is that service appropriate for anything on that list of diagnosis on her record. If so, the insurance will pay it. But I think that whole thing is difficult unless it's presented to the jury in exactly those words, and it wasn't. I had to really pay attention and glean this understanding from what was presented, it was laid out in that cut and dried fashion. I guess it boils down to if there are even a smidgeon of a way for two sides to look at something it goes to the jury, i.e. both sides made some kind of presentation, so no matter how ridiculous or clear cut, a judge doesn't just give a directed verdict.

There is still the open question of the "IJ", which appears to be the period of time that two surgeons were hired on and allowed to continue doing infant heart surgeries in spite of bad outcomes and apparently employees going to management about it. I think if the plaintiff is able to tie the management of the Heart Institute back to the management of the main children's hospital that will be a huge problem for the defense on a couple of their counts.

Today apparently there were deposition(s) on that issue.

[RVInit]

Cross Posted from Something Pretty Cool thread

I can't believe what I did today. I actually decided to email three of the attorneys (all the same email) with a couple of my insights about CRPS as a person who has this condition for almost 24 years now. I gave a little bit of my history, how I came to believe that Maya doesn't have this condition and some of my feelings about seeing Maya as the public "face" of this condition.

The main purpose of my email was to share one particular insight that was touched upon during trial and pretty much dropped and that is a dead giveaway that Maya did not have severe pain, nothing of the sort that you have with CRPS. That has to do with pulse rate.

I wrote about the pulse rate thing here: viewtopic.php?p=225221&hilit=pulse+rate#p225221

I also shared links to the two topics where we discussed the trial and mentioned that I added my own insights and commentary to those discussions, based on my experience with this condition.

I received a really nice email back from the attorney that I was so very impressed with, telling me he had actually not put the pulse rate thing together and that he is going to use my insight as to pulse rate/pain in his closing argument. Pretty cool, huh?

I felt so silly sending an attorney on a big case an email, that is just not me. I almost didn't click the send button after I typed it. Then I thought, what the hell. I'm a goofy old lady, have at it.

[pipistrelle]

Good for you.

[Flatpoint High]

Brava!!!!

[keith]

Yeah, super plus good.

But my question about it is was the pulse rate issue brought up appropriately that it is useful to 'work it into' closing with good effect on the jury? I mean, of course that is up to the attorney to figure out how to do that, but if they didn't see it when the testimony was happening, and didn't point it out at the time, did the jury really hear it?

"Tell 'em what you are going to tell 'em", "tell 'em", then "tell 'em what you told 'em". Opening, Testimony, Closing.

If you didn't do the "tell 'em" part are they gonna pick it up in the "tell 'em what you told 'em" part?

[RVInit]

Yeah, super plus good.

But my question about it is was the pulse rate issue brought up appropriately that it is useful to 'work it into' closing with good effect on the jury? I mean, of course that is up to the attorney to figure out how to do that, but if they didn't see it when the testimony was happening, and didn't point it out at the time, did the jury really hear it?

"Tell 'em what you are going to tell 'em", "tell 'em", then "tell 'em what you told 'em". Opening, Testimony, Closing.

If you didn't do the "tell 'em" part are they gonna pick it up in the "tell 'em what you told 'em" part?

The interesting thing is that Maya had a single instance of tachycardia, I think her pulse rate was 136. For an adult that might be alarming, but for a 10 year old it's not really that much higher than the high range of normal.

But one of the plaintiff's CRPS doctors brought it up. He said it's a clear sign of someone in pain. But then they dropped it, because Maya only had one single instance of it. So, they were trying to add up all the little signs that Maya really was in pain, but they didn't spend time on the pulse rate because I think they just wanted to jury to hear "one more sign of pain" but not really dwell on it because the facts aren't there for any other instance of it.

So, yeah, I think the defense can remind the jury that their own witness told this jury that tachycardia was a clear sign of pain. But look how many times, every single record except for one single instance, where Maya claimed to have 10 out of 10 pain and yet her pulse rate is 75. Which is the low end of normal for a child. A 10 year old normal rate is 70-120.

[Tiredretiredlawyer]

RV - Your excellent summaries got me hooked on this case! Hubby is unsure how to feel about it. I tend to get obsessed with trials like other Fogbow members do. Hubby is then afflicted by me reading many internet articles and watching TV shows covering the trial. He likes to watch TV shows we both enjoy. (In my defense, HE watched Vikings more than once. I couldn’t take all the babies screaming.)

This trial has been fascinating and I appreciate your daily posts!

[pipistrelle]

It occurs to me asking a child to rate pain is problematic. When I was 5, an earache would have gotten a 10 out of 10 (probably would barely register today). When I was 5, the gravel burn on my knee from a bike fall (where we had to pick out gravel chunks from raw skin) would have gotten at least an 8 out of 10. Now something has to be much more painful than either to get a 10.

Also, it took a while to notice this, but if I'm at a high level of pain overnight, the next day my Fitbit registers a high (for me) resting heart rate. It doesn't usually get high enough to worry about but it's 10 to 20 beats per minute higher. It's consistent.

There are some studies that show the correlation between chronic pain (not at CRPS levels but probably more at my level) and increased heart rate is not as great as is commonly thought. But hard to believe someone feeling 10/10 pain is going to be at the low end of normal.

[sugar magnolia]

It occurs to me asking a child to rate pain is problematic. When I was 5, an earache would have gotten a 10 out of 10 (probably would barely register today). When I was 5, the gravel burn on my knee from a bike fall (where we had to pick out gravel chunks from raw skin) would have gotten at least an 8 out of 10. Now something has to be much more painful than either to get a 10.

Also, it took a while to notice this, but if I'm at a high level of pain overnight, the next day my Fitbit registers a high (for me) resting heart rate. It doesn't usually get high enough to worry about but it's 10 to 20 beats per minute higher. It's consistent.

There are some studies that show the correlation between chronic pain (not at CRPS levels but probably more at my level) and increased heart rate is not as great as is commonly thought. But hard to believe someone feeling 10/10 pain is going to be at the low end of normal.

That's why most pediatricians no longer use the numerical 1-10 scale. Now they use a 1-10 scale with pictures of smiley faces. From to . Even my almost 3 year old granddaughter can do that one.

[RVInit]

It occurs to me asking a child to rate pain is problematic. When I was 5, an earache would have gotten a 10 out of 10 (probably would barely register today). When I was 5, the gravel burn on my knee from a bike fall (where we had to pick out gravel chunks from raw skin) would have gotten at least an 8 out of 10. Now something has to be much more painful than either to get a 10.

Also, it took a while to notice this, but if I'm at a high level of pain overnight, the next day my Fitbit registers a high (for me) resting heart rate. It doesn't usually get high enough to worry about but it's 10 to 20 beats per minute higher. It's consistent.

There are some studies that show the correlation between chronic pain (not at CRPS levels but probably more at my level) and increased heart rate is not as great as is commonly thought. But hard to believe someone feeling 10/10 pain is going to be at the low end of normal.

That's why most pediatricians no longer use the numerical 1-10 scale. Now they use a 1-10 scale with pictures of smiley faces. From to . Even my almost 3 year old granddaughter can do that one.

Excellent points, Sugar and Pipistrelle.

[RVInit]

One of the things I hardly touched on was Beata's medical porn and financial grifting. And the surprise that came out in court, that she was actually applying for Social Security Disability very early in Maya's medical history. And I think these things, combined with at least three examples of Beata seeking diagnoses and/or treatment for conditions Maya didn't have, helped Dr Sally Smith make an actual opinion and diagnosis of MBP/medical child abuse regarding Beata.

The medical blogging and seeking of government disability funds are known by the jury to a limited extent. I'm not sure about the GoFundMe, I can't remember if I ever saw any of that, I will listen for it in the closing.

Beata was blogging every detail of Maya's medical life and posting photos of her daughter, especially the ones showing all the tubes and "life support" equipment she was hooked up to down in Mexico and probably every time she took her to any emergency room or PICU. She surreptitiously took video of the visits to Dr Mendez, who was one of three Immunologists that she sought immune deficiency dx from. I don't know if she posted those on her blog, but if you want an idea of those videos, parts of both of them are shown in the Netflix show. Who does that?

I think this goes to the psychological need for attention and sympathy. And I'm wondering if links to GoFundMe appeared at the bottom of the blogs. The judge limited this evidence quite a bit, so I'm not sure the impact that it will have on the case, I don't know the history of why the dependency hearing things were not included in this case, but it would be helpful for the jury to have a more full picture of what was going on.

I think the Kowolski family may be looking at years of appellate hell if they do win any of the counts, which I believe they will win at least some of them. Hopefully they won't win the big one - medical malpractice by the hospital. There is really not the evidence of it, and if you read my initial impression of the case I am totally surprised that I am convinced that Beata was seeking and sometimes getting dangerous and unnecessary treatments for Maya. I am squarely on the side of the hospital once the evidence became just too overpowering for me to think otherwise. But I'm also aware of some things the jury isn't aware of, and some of what they do have may have far less impact than it should because of the judge limiting it so severely.

And if the motion to dismiss juror #1 fails and that person becomes one of the six. Forget it. He will probably beat down the other jurors until they just give it. What the hell, a hospital has tons of money and insurance. I can see a jury finding that way. And this will have huge implications for hospitals that suspect medical child abuse if the K family gets a win here.

[pipistrelle]

Didn’t realize there was a motion to dismiss a juror. Did the defense catch into him?

IANAL and am not seeing what justifies leaving out so much evidence that supports the defense.

[RVInit]

Didn’t realize there was a motion to dismiss a juror. Did the defense catch into him?

IANAL and am not seeing what justifies leaving out so much evidence that supports the defense.

There is a juror, juror #1, that has been wording his questions as if he is an extension of the plaintiff legal team. And not just once the defense case started, he was clearly gunning for the K family from day one. There is a thread on reddit all about this juror. At first we didn't know if it was a man or woman, but the defense made a motion to release juror #1 from the jury and all the examples of questions they gave were the same that those of us watching the trial have remarked on. And the motion refers to the juror as "he" and as "juror #1". They informed the court they would be making a motion to dismiss a juror last Friday. And one of the "legal" youtubers had a copy of that motion.

I've been staying away from listening to any of the legal YouTubers talk about this case, what I find is that they cowtow to their subscribers obviously because that is where their money comes from. So, if the majority of their subs think one way that is what they think as well. And the general public is squarely on the side of the family in this case. There is one feed, Law & Crime network, whose chat section started taking a turn for the defense once the defense started putting on their case. But that's only a handful of the chatters, the majority of them are just ignoring or dismissing all the defense testimony because they were just baked in solid for the K family right from the beginning and nothing is going to change their mind. Very much like juror #1, which comes through loud and clear in the wording and tone of his questions. In Florida civil cases the jury can ask questions of the witnesses after the cross exam. Then the attorneys can follow up based on what they think the jury is thinking with their questions.

[RVInit]

This case just turned into a shit show.

The feed was late coming on and the arguments were well underway by the time it came on this morning. So, I don't know the whole of it.

But the judge is angry about and his decision so far is that yes, this all came about because of the heart Institute. (My keyboard is acting up, I can't type a capital h.) But, there was something about the Risk Management team that some of them lost their jobs over it, and Risk Management was over both buildings, so the just kept saying there COULD be a view that it was systemic and their COULD be a view that this matters for when Maya was in the hospital, so he's going to allow the plaintiff to enter a shitload of exhibits to rebut testimony by the defense that the hospital was fully accredited, otherwise they could not have billed patients - except that the witness made statements that the judge felt went beyond that where this rebuttal is going to be allowed.

he doesn't want to get into a "mini trial" at this late date because time is already a problem. But a mini trial is what the hospital needs so the jury gets a full picture. The facts are the hospital Maya was in was not the same building, she was cared for by doctors, nurses and other staff that are all still employed, and the limited problem involved people who were all fired.

While this was being argued, Mr Anderson brought up that juror #1 had asked a question regarding this particular thing. And that also brings in the fact that how would he have known to ask a question about it unless he was remembering things he read int he newspaper about the heart Institute many years ago. It really is just one more instance of that juror bringing bias into the case right from the beginning.

They have not talked about the motion to dismiss the juror. But apparently the deliberating jurors are already known, and he is one of them if they don't boot him.

[RVInit]

Maya is making big time eyes at juror number one again this morning. She looked at him for a very long time. I bet they will be dating when this is over with.