Taking Care of Maya - FL CPS/Munchausen case

[RVInit]

Just spent the night reading this whole thread. Many thanks for the immense effort in distilling everything!

I continue to be astounded at the Boogle’s experience and expertise. Amazing.

The write up saus Mr. Banker spent many years at “ Geisner Health.” I think that should be Geisinger Health System in Danville, PA. It’s huge and all over Central and Northeastern PA. Various members of my family have been consumers of their care for years.

I'm trying to type as fast as I can through the testimony, and I have to stop it periodically to catch up. And I never heard of these hospitals so, yes I probably misspell or mishear the hospital names at times. Thanks for clearing that up, I believe you are correct about that, I'm pretty sure he did say it was in Pennsylvania.

[RVInit]

He’s asking her the same as he asks every witness about were you part of the decision to put the commode out of her reach or make the nurses move slowly so she would urinate on herself?

Well, isn't that a leading question, with the assumption of the motive "so she would urinate on herself."

I'm not sure I know what preferred testimony is but I don't get why the idea of a suspicion of medical child abuse isn't allowed as a lot of the boxes were checked.

I suspect Maya the near adult has $$$ in her eyes. On her "good days."

I think I remember hearing some of the IAALs answering this kind of question on other trials by saying that the "other side" can ask leading questions. I know I often see that when I watch trials, that the side that puts the witness on can't ask leading questions, but the other side can. I find all the intricacies about trials and legal argument to be fascinating, I can see why someone would want to be a lawyer, seems like it would be a very intellectually stimulating profession.

[RVInit]

I don’t see what kind of harm they can claim was done to them due to the hospital charging Aetna for hospital room, physical therapy, a few hours of psych time, and medications.

The only thing I can think of is if their insurance has a maximum payout after which the insurance company doesn't have to pay any more. If the hospital fraudulently charged the insurance company, then it could lessen the amount of insurance benefit the K's had remaining to use for subsequent care. You'd think they'd mention that, though, if that were the case...

ACA eliminated lifetime maximums. Plans usually have an out-of-pocket limit per year, which these people would have used. I'm surprised the insurers didn't have their medical people monitor this with all the out-there diagnoses.

These are all excellent points. I will keep my ears open for any of the discussion and arguments relating to this count. I don't recall hearing any of these, but I wasn't following pretrial motions or anything like that, so maybe most of the discussion about this count happened outside of what I'm aware of. But I appreciate the thoughts, it gives me some things to listen for to make sure I note them if they come up.

[Kriselda Gray]

ACA eliminated lifetime maximums.

Oh, cool - that's good to know!

[pipistrelle]

ACA eliminated lifetime maximums.

Oh, cool - that's good to know!

I misspoke. Only for essential health benefits.
https://www.healthcare.gov/glossary/ess ... h-benefits

[RVInit]

I was having another thought about this. The judge has already determined that the hospital had legitimate reason to contact the abuse hotline. They have immunity from anything that arose from the fact that she ended up sheltered. Her room and board were the majority of the charges, and that is regardless of any actual diagnosis she had. The amount of room and board charged are directly related to the dependency court requiring Maya to be sheltered in the hospital. Also, if the diagnosis of CRPS has been removed from her record, there was not a single treatment that she received that would not have been considered medically necessary based on all her other diagnoses.

I think his lawyers may try to argue that had Maya "been allowed" to leave prior to Nov 14, yes, the hospital bills would have been less. Beata would likely have taken her back to the quacks and they were using GoFundMe to pay for all of that. So, that may be how they argue the charges would have been substantially less.

Mr K made two different claims about what the hospital said about them leaving AMA. First, he claimed the hospital threatened to have the family arrested. Then, he changed his testimony to the hospital threatened to call security. That might hurt him if a juror took good notes and remembers that he told two different stories under oath.

Multiple members of the hospital staff said that they explained to the family why taking Maya out while she was still being weaned from pain meds would be against medical advice. But they also said that legally they have to allow any person to leave the hospital AMA if they still want to leave after they explain why it's AMA. The only additional thing the K family was told was that because a hotline call had been made, the hospital would have to contact DCF just to tell them that Maya was no longer in the hospital.

Mr K comes across as something of a nincompoop. He seems to want the jury to believe that he just doesn't understand things. This whole family is playing very heavily on sympathy. Poor Maya was traumatized by the hospital. And Mr K was victimized because he just didn't understand things.

[RVInit]

Defense wants to admit an exhibit that plaintiff wanted redactions on. Crowells says the redactions are done, and asks the plaintiff if they have looked at it, they (surprisingly) are OK with it now. Oh, wait, now they are raising a new objection. Tuff luck. It’s coming in, they previously agreed to redaction, redaction made. The end.

Both sides were given 50 hours of time to present witnesses and cross examine. The plaintiff’s have used almost 57 hours and the defense has used 36 hours.

They talk about when the defense will rest and discussion is along the lines of defense saying they have three more witnesses in person and 3 depositions for Monday. They point out that they are trying to wrap things up with fairly narrow questioning and depending on how much time the plaintiff uses to cross examine, they will try to get their witnesses finished by Tuesday or Wednesday morning. Testimony is supposed to wrap up by Wednesday end of day and plaintiff gets to put on rebuttal witnesses.

Mr Anderson starts whining (I hate that whiny voice of his) that he has the burden of proof. The judge isn’t saying this, but he has, in the past, been frustrated with the fact that he keeps giving the plaintiff more time, and Mr Anderson chooses to badger witnesses over and over and over again on points that the witness is clear, is not going to change their mind, is not going to be bullied, and many times the judge calls the attorneys up to the bench and then Mr Anderson is finished with the witness. I’m pretty darn sure the judge is basically telling him “you are done with this witness” and that’s why once they come away from the bench Anderson says “no more questions”. He is ridiculous. He was originally give four extra hours but he has used those 4 hours and 3 additional hours and we still have 3 more days of testimony. He’s 7 hours over his total time limit at this point.

The judge is asking the defense about how much more time they need for their witnesses and Ms Crowells wants to clarify her understanding that the defense has now been given a limit of 59 hours for their case including rebuttal. The judge says yes, that is where they stand. And she indicates that the defense is trying to make sure the plaintiff can get their rebuttal in, but that is going to depend on how much time they spend cross examining the defense witnesses. The plaintiff brings up that there will probably be a motion. So, they are going to continue to use whatever time they want and force the judge to give them more time. The judge answers Ms Crowells “that is what I have previously said”.

I think the judge will end up giving the plaintiff even more additional hours. Based on what I have seen of how much time they waste, no matter how many times the judge tries to give them hints, then outright tells them in open court (without jury) that they need to start using their time wisely. They have 2 hours left until reaching 59 hours. I don’t see them being able to cross examine remaining defense witnesses and still have time left for a rebuttal case. I don’t know if the judge is required to give them a rebuttal. They are really taking advantage of the court at this point. The judge indicated that before any motion please talk to both sides. This would be a motion for the plaintiff to get more additional time. They got 4 hours, then obviously got another 5 hours and have only 2 hours left, which is not going to get them through cross exam and a rebuttal case.

[RVInit]

Today is going to be the second witness that the plaintiff has been demonizing. The first one, Sally Smith, was definitely a huge win for the plaintiff, there was no demon there. It was easily shown that she did not intrude on Maya's care while Maya was in the hospital. And it never made sense that she would.

Exhibits for Cathi Bedy testimony are being entered and they show an entirely different picture than Mr K testified to. He claimed that the hospital, and specifically Cathi Bedy limited his visits with his daughter even though the court said unlimited. He was required to arrange them in advance. He did this via email and every one of his emails specifically requested a one hour visit. Although I'm sure the hospital would have allowed him to stay longer had he wanted to, he was the one who specified that he only wanted a one hour visit. The more evidence the hospital puts on, the more Mr K looks like a liar. And then Maya claiming the same thing. She was 10 years at the time and 11 when her father filed all the lawsuits. The family definitely to their stories all straight with each other. But the contradictions to their testimony are coming in the form of exhibits as well as testimony.

Also the famous Christmas dress. Wouldn't you know, one of the exhibits they are arguing about are photos of Maya showing her wearing red dresses for Christmas. This family is just plain nuts.

And here's a big thing. Both Maya and her father on the witness stand under cross exam when confronted by exhibits, photos, audio of police interview, etc, that contradict their direct testimony explain things like "I lied at the time so I could go home" or "I lied at the time so I could bring Maya home".

So, I can just hear the defense closing argument. "You heard from both Maya and her father tell you directly that they were willing to lie to get something they wanted. And now they are suing the hospital for $220 million dollars".

[RVInit]

Defense witness Cathi Bedy, licensed Social Worker
Highlights of her testimy

She was specifically asked by her supervisor to stay on Maya’s case because the SW that was assigned to that floor did not have any experience with handling sheltered children. The SW that did not have this experience wrote an email to Cathi that indicated her understanding was that Chi “wanted” to stay on Maya’s case. Supervisor specifically asked Cathi not to say anything to the effect of “you aren’t qualified” to the other social worker, so Cathi did not correct her on the fact that it was the supervisor that asked Cathi to stay on Maya’s case.

Cathi was the middle person between DCF and Maya and often had to deliver what would have been sad news to Maya regarding contact with her mother. She was required to be the person to tell Maya that she would not be able to go home for Christmas. Maya began crying and asked if she could sit on Cathi’s lap. At the time Cathi saw no reason to be mean to Maya and allowed Maya to sit on her lap. She tried to comfort her and tell her about the activities that take place in the hospital. (Maya claims that Cathi pulled her onto her lap against her will). The door to Maya’s room was always left open partially so that nurses and other staff walking by would be able to see if Maya was OK and not laying on the floor. So, at no time during any time Cathi was ever in Maya’s room would the door have been closed.

(This is the second facility that there has been testimony that Maya claimed to have fallen and laid on the floor with nobody helping her for a long time. In neither of these cases did Maya report this on the day that it happened. She never could tell the same story about what exactly happened in either case. One of them she told at least three conflicting stories about the fall to different staff members when questioned about her alleged fall. She was examined and found no bruising or any other evidence of a fall in either case. But both facilities put her under “fall risk” status. )

Cathi was given a verbal reprimand over an incident with a less experienced SW. That social worker had told a family that Cathi would give them a $50 gas card so they could use it for food. The family lived only 5 miles from the hospital and Cathi had to document all the gas cards and could not give the gas card to a family that lived this close, it had to be used for gas only and had to be a family that lived far enough that this would reimburse their gas expense. Since Cathi is the one who as assigned to that particular family she is the one who had to actually interact when the time came to provide the family with any actual assistance. She was upset being she knew this family was poor and she was going to have to tell them she could not give them a $50 gas card that they probably really needed the financial help. She said she kind of lost it with the coworker about being put into that position.

Exhibits were shown of all the correspondence between Jack and Cathi. Based on the tone of Jack email it was clear that during the time Maya was in the hospital there was no animosity and even quite a bit of friendliness in those emails on the part of both Jack and Cathi. Jack dropped off a bag of clothing for Maya on Dec 22. He sent Cathi an email about it, but she did not see the clothing in her office. She went to a room where all the social workers would sometimes have meetings and found the bag there the following morning. She wrote an email back to Jack K letting him know she found the bag in the SW common room and had taken it to Maya’s room. She did not search throughout the bag to see or count the amount of clothing, but she took the unopened bag to Maya’s room and let Jack know Maya had received the clothing.

(Maya and Jack claim there was a “red Tommy Hilfiger dress” that was not delivered to Maya.)

Exhibit Photos were shown of Maya and her brother on Dec 24, and Maya on Dec 25. Dec 24 Maya was wearing a sleeves red dress. On the 25th the photo is taken from a side view. Maya was wearing a long sleeved dressy sweater over something that was hard to see, but at the bottom of the photo the portion of the clothing underneath that was showing was red in color.

Mr Anderson is now saying to the witness “You don’t see a CREAM colored Tommy Hilfiger dress, do you ?” on cross examination. Both Maya and her father testified that it was a red dress that had not been delivered to Maya. I guess they are changing it to cream colored because photos clearly show Maya wearing red dresses.

Maya asked Bedy to pray the rosary with her on at least one occasion.

The defense spent a lot of time badgering her about "Maya didn't like you did she", etc. I have the distinct impression that Maya was fine with Bedy at the time she was hospitalized, but now that the family has a lawsuit they selected her as one of the demons. Of the objective evidence, emails, the tone of those emails was clearly friendliness between Jack and Cathi Bedy. So discounting BOTH of their claims, leaving the objective evidence only, I would say the family had no problem with Cathi Bedy during the time of Maya's stay in the hospital. The jury will have those emails.

The jury questions are as expected with at least one juror asking pretty aggressive questions of a defense witness. That has become pretty standard in this case. Will be interesting if that juror ends up deliberating. There are 12 on the jury now, but in Florida it will be 6 actually deliberating.

[RVInit]

Judge is getting antsy about how much time is left. The plaintiff is continuing to waste time on cross exam, but the judge is concentrating his demands about finishing SOON to the defense. They have more than 20 hours of their 50 hour allotment left. It sounds like the judge is trying to bully them into being the ones to take less than 50 hours so that the plaintiff can have time.

Now, he’s finally trying to get Mr Anderson to cut his time for rebuttal down to a couple of hours. He wants to know WHO they are going to bring in. Anderson first said he needed 6 hours for rebuttal. The judge went ballistic, telling him he has NEVER been able to put 6 actual hours of testimony into a single day with all his objections and sidebars and everything else. The defense is nowhere even close to running out of their time. He has to allow them to put on their defense case.

Assuming the defense rest of Wednesday and the defense has 2.5 hours of rebuttal, will the defense be able to do their cross by Monday? The only way we will be able to finish by Wednesday is if the court hold the plaintiff to the remaining time they actually have left based on giving them 59 hours.

The judge points out the plaintiff used 25 minutes cross against a 1 hour direct and that is not exactly succinct. To which Mr Anderson does his usual whiny “yeah, I know….”. The defense Mr Shapiro, with whom I am constantly impressed tells the judge they will object if the plaintiff is given any more time beyond the 59 hours. (the defense has really had it with Mr Anderson) he says the defense may be able to rest even by 1 PM on Wednesday if the defense is held to their clock. Which would give the plaintiff time for rebuttal. He says he is gravely concerned that if the plaintiff is not held to their shock(?) clock (not sure if I’m hearing that term properly, any IAALs can clear this up?) that we may have difficulty finishing by Wednesday. If they are held to their remaining time, we will finish by Wednesday.

Mr Anderson admits that Ms Bedy was not his best effort and claims that Ms Bedy was a little difficult to control. (That’s nonsense, she was very cooperative with both sides, there were a lot of objections, sustained by the way, because his questioning was the problem, not Ms Bedy.)

Next witness is in the Zoom waiting room, it’s time for jury to come bck

My overarching view is that we are on week 7, generally speaking the plaintiff’s have done cross exam, somewhat succinct except for a couple of days. Ms Croweells gets angry at this and points out that the defense has been held to their time, their average of cross minutes to direct minutes has been far less than the plaintiff and they just keep asking for forgiveness every single day. (that is the damn truth of it). The judge is making excuses for the plaintiff, burden of proof, they’ve average one minute of cross to 2 minutes of direct (except when he read how many hours to how many hours that does not add up, only for this morning a single witness was it that ratio. For some witnesses the cross was MORE TIME than the direct. In one case FAR MORE TIME, but many cases equal or more time. This is crap coming out of a judge’s mouth at this point. I think the defense is probably boiling at this point) My understand of case law is that if the judge gives the time, and the party that uses up their time and needs more time, if they can show they used their time appropriately, and specific issues addressed, then I HAVE to give them more time. (I believe the judge is contradicting his own self at this point. I don’t know if I have documented within this thread how many times the judge has had to literally shut the defense down during cross because they are droning on and on and on over the same thing and getting nowhere and also reminding them of their time. But I think I have documented some of that at least if not all of it)

Ms Crowells says her understanding is that they would have to show what exactly they need to do that they haven’t been able to do, and in this case it’s supposed to be TRUE rebuttal and not just putting on the witnesses again to just deny whatever we put on. So we suggest that before the court consider giving them any more time that they actually proffer verbally what their “rebuttal” is so that we are not putting this jury off for what’s really not rebuttal.

The judge says that the defense needs to give him a case to show that his understanding is incorrect.

Mr Shapio says we have 20 hours left and these are witnesses necessary to our case. What we are concerned about is being asked to cut down on our allotted time and not being able to put on witnesses that are crucial to our case so that we can give them more time when they have been constantly warned throughout this case to use their time more wisely. And it should be true rebuttal. They called a lot of unnecessary witnesses, like a grandmother who had nothing to do with this case, who needed a polish translator, which took a lot of time, and that’s just one example.

Now the judge is looking at trial days, the defense has had 10 trials days, the plaintiff has used 13 trial days. Shapiro points out how much of the defense trial days are being consumed by the plaintiff as oppoed to how many hours of plaintiff trial days are being consumed by the defense.

(this is crazy of the judge. So, when the hours make the plaintiff look bad, he wants to start talking about days. OMG. I am really seeing that the more things are in favor of the defense, the more unfair this judge seems in trying to tip things in favor of the other side, even using stupid arguments at this point)

We do not want to see a mistrial if I do not give them an additional 2.5 hours for rebuttal. He repeats that they plaintiff needs to be judicious with their time.

[RVInit]

The plaintiff doesn't want an expert, Dr Levy, who is an addiction specialist, she is going to testify about ketamine (and probably Maya's documented behavior in the ER where she was not saying "I'm in pain" she was saying "I want my f....ing ketamine". And "I wasnt my f.....ing morphine".)

The judge is saying he's wondering why he's dealing with this argument by the plaintiff at this point right before the witness is about to testify.

[RVInit]

Nurse Thatcher

PICU is where she ran across Maya Oct 7-8 and Oct 8-9 (I think night shift)

What does she recall? Very tense environment. Maya was belligerent and cussing. Maya’s mother was anxious and demanding sedation for Maya.

(This is also a pattern. I believe this is why Maya needed more and more ketamine over time. Once my doctor came to the conclusion that my pain was not going to be acute and is going to be chronic, at that point we had a long talk about how chronic and acute pain management are different. Acute pain is short term. Overmedication, i.e. bringing the patient pain down to absolute zero is generally not dangerous, not addictive. However, once you are chronic, they have to take an entirely different approach. If a pain management doctor treats a chronic pain patient down to zero pain, your brain adjusts to that, and you need more and more and more over time to get the same zero pain. So, once you are chronic, there is no going down to zero pain, if they ever got your pain down to zero to begin with. Bottom line, a chronic pain patient has to learn to live with fairly significant pain, otherwise they face the problem of needing dangerous amounts of medication to keep them at a lower level. Maya was being outright SEDATED during her treatments. The only photo of her in Dr Hanna’s treatment center shows her absolutely unconscious. Of course she was addicted, and of course she was behaving as an addicted person acts when she entered the ER/PICU)

This nurse also noted that there was very different behavior by Maya when mom was in the room vs mom not in the room (she’s one of many who testified to noticing this behavior)

When Mom was in the room Maya ws agitated, angry, cussing. Mrs K was coaching her to behave that way. She was saying things like “Maya, you tell them. Tell them how angry you are.” It was really hard to get the room to calm down. At one point Mom stepped out of the room for about 15 minutes and during that time Maya changed completely. She became very pleasant, she was very age appropriate, kind, used kind language, I really emjoyed those moments with her.

It's not typical for a child to change their behavior so drastically and yes, I was concerned about that.

Briefly go through charting. First note from Oct 7, 2016. Top third of the page. Other – family demanding to see physician because current medication not enough to put patient to sleep. (yep, there we go again with the sedation, which even Maya demanded in those same words at times). This was a recurrent request from both Maya and Mother.

10 PM Oct 7 Mother asked her to “push some propofol to prime the lines with med”. Propofol is general anesthetic and sometimes used to do sedation for procedures in ICU. The quote was direct from Mrs K. When hanging a medication we have it coming in as med with fluid and when we hook in another medication it cane take a couple minutes for the line to carry in the other medication to the vein. Priming the line means to put it directly in immediately. Propofol is one of the few medications that in the state of Florida nurses are prohibited by law to “push”. Mrs K told her that she is an infusion nurse and so I knew that she knew this. The nurse was shocked that Mrs K would ask the nurse to do something illegal for her to do.

I told her I could not do that , I would administer as normal.

Oct 8, 2016 – focus on bottom third of page. Note reads: “Father stated that patient is awake and needs to be put back to sleep. Patient is showing no signs of pain but father states that she is starting to look anxious”.

She also interacted with Jack K. She doesn’t remember most of her interactions with Mr K and to her that’s probably because most of them were appropriate and so, she wouldn’t specifically remember that. But this one occasion was different and she noted it for that reason. She did not believe Maya needed any mediation, she did not notice any anxiety that normally accompanies pain. PRN means it’s available and she can give something.

Note from midnight of Oct 8 – Describe for jury what this note indicates. This note I remember very clearly. Maya was agitated and was removing all the nodes that were monitoring her. We needed those because the medications she was on required monitoring BP, heart rate, and other vitals signs. She was pulling at lines and IVs and tried to explain nicely why they were needed and Maya responded (she apologizes to the jury for the language) “I don’t’ give a fuck what the doctor wants”. Maya was cussing a lot, through most of the interactions with her. This one really stood out and showed she didn’t care what the medical team thought. The mom is asking for more propofol during same time period

Oct 8 2016, bottom of page – Patient is screaming that the hospital is full of a bunch of liars and are refusing to sedate me. Patient is told that we are trying to keep her as comfortable as possible while keeping her safe and able to breathe on her own. She reads to herself.

Pt refers to Maya K. she remembers Maya calling her liars, that was a common statement by her. We don’t lie to patients, sometimes to the point where it is hard for the patient to hear. Nurse has never lied to a patient and it bothered her to be called a liar by a 10 year old and she’s calling everyone at the hospital liars. We were giving her a lot of pain medications and trying to keep her comfortable. While she was showing a lot of belligerent behavior she wasn’t showing signs of having actual pain and wasn’t even saying she had pain. She was demanding “sedation” (which coincidentally she was hearing her mother demanding as well)

She is following physician orders.

Next note shown to witness and jury but not on video screen. Maya was demanding that “Valium be pushed fast”. They don’t push valium fast because it can reduce blood pressure too much if given too quickly. It’s hung in a drip and administered slowly enough to prevent adverse and dangerous condition to arise. This is very early in her hospitalization and again, it’d odd for a 10 year old to be using this kind of medical language. There is often a euphoric sensation that would follow a “fast push” and she was concerned that this is what Maya wanted. She was very little and concerning.

She tried to advise her that it was not in her best interest. It doesn’t help with pain. Sedation and pain meds are different. Valium is for anxiety not for pain.

Maya also asked specifically to be sedated. At this point in Nurse Thatchers career she had over 25,000 hours of clinical care and can’t recall as single instance of a child asking for “sedation”.

Over the evening of Oct 8,2016 transported Maya for CAT scan. Was a couple of hours into shift, she had been very agitated, wanted to be sedated, screaming, we tried to work as a team to make her comfortable. She fell asleep and Thatcher remembers thinking how good this will be for Maya, she’s finally asleep, she’ll get rest, maybe wake up and feel better. She thought Mrs K could also get some rest because she had also been very agitated all evening.

I didn’t even make it back to the nurses station before Mrs K said “this would be a great time to take Maya to get her CAT scan”. I didn’t understand, we finally got Maya to get some sleep after hours and hours of trying to calm her down and get her comfortable, and now we are going to wake her up for a CAT scan when she’s finally calm and sleeping.

I told her why don’t we wait and let Maya get some sleep. She insisted. So, the nurse had the conversation with the attending physician and he said if the mother is demanding it now, then let’s do it now.

Maya tolerated the CAT scan, did not moan or complain during the scan, the nurse thought this is good, she’s calm, behaving well. I was proud of her for her behavior during the scan. Beata offered Maya a reward for good behavior during CAT scan. She had to take another nurse because of all the tubing and emergency equipment that had to go with her because of her medication.

Beata had told Maya if you are good I have a treat for you. Nurse didn’t think anything of that, they use rewards at the hospital, stickers, ice cream, things like that. Very common to give rewards.

What happened after the CAT scan and going back to room. After the scan we were on the other side of the wall, Maya was starting to come out and I just got there and Beata said “Maya you did so great, now you get Valium”. I stopped in my tracks, Maya has not indicated any agitation or pain or anything. We never offer controlled substances as rewards. That is unheard of in any hospital ICU setting.

Was an entry put in her chart as to the Valium reward instance.? Yes, I was very upset about that. It was totally inappropriate. Is this note a fair and accurate depiction of what you remember happening? Yes, I remember it clear as day.

Bottom of page. We were in family meeting, using the term loosely, out of bed space to discuss the child. Mrs K was upset as to her opinion of the lack of medication we were giving Maya and stated that we might as well contact hospice so that Maya could have more medication. She thought Maya might as well die rather than to have to live this way.
That was concerning, we deal with death and dying all the time. These children who go through end of life, we put our heart and soul into their care, and they have been through a lot. Maya was not a terminal patient and I was chilled when she said this. There was nothing in Maya’s situation that indicated she was at risk of dying.

Have you ever experienced interaction between mother and daughter anything like what you witnessed between Maya and her mother? Not up to that time, and not since that time

She was concerned for Maya’s health and well being because she did not believe Mrs K had a limit or ceiling regarding what she was willing to do to get Maya medications that Mrs K thought she needed. But the care team could see that Maya’s pain was under control, especially when Mom not present. She appeared to have no limit.

Plaintiff
Her pain was controlled, she had highs and lows, but she definitely was under control much of the time.

She wrote down at a specific time Maya claimed 10/10 pain. That is something Maya would state, not what I observed. I did not rate it a 10, Maya reported she had 10

Beata said Maya should be given hospice and given enough medications so she would die. I did know about Maya, I cared for her. I did not know Beata that well. I knew that Maya was not terminal.

We were giving her a continuous infusion, we gave her additional PRN, we treated her pain, we took her pain seriously

I was not the one determining her pain regimen, it was physicians and pain team.

I don’t recall who the attending physician was on each particular night. I spend about 10 or 15 minutes each night with physicians. Things I do with patients are continuous all night long.

I did not get a summary from attorneys about my testimony. I can only testify as to my notes. Beata disagreed on a number of things. She had an accent, I don’t know where from. I’ve seen other children acting out. I see upset people all the time. I heard a lot, I may not have “heard it all”.

I’ve heard parent curse before. I don’t recall whether the parents cursed, she was an adult, Maya’s cursing was unusual. Parent cursing is not going to be documented in nursing notes. Everything you put down you have heard before? No, not true

I’ve heard mother exaggerate. And about pain. Oh, now CRPS again I’ve seen lots of pain patients, it’s rare we don’t see it often. I am aware we have pain team on staff. There is always a pain team member on staff in hospital at all times. The ICU attending physician is the ultimate “in charge” and they always take into consideration other team members.

Beata did not tell me why she thought it was a good time to get a CAT scan. Mrs K was refusing to take Maya for the scan all day long until Maya was asleep.

Maya had been given some doses of Valium before. I don’t remember talking to Beata about giving Maya valium, it was Beata statement to Maya that she should get Valium as a reward for being good.

Nurse is not an expert on CRPS. Did you ever sit down and actually talk to Beata? No, I would try to talk to her but she was just not interested at all. She only wanted to tell me what to do.

Doesn’t know who Debby Hanson is.
Jury questions:
1. In interest of ruling out all, when Maya said “I want to be sedated” she was not singing or refereicing a song? No, she was yelling to us she was saying “sedate me, I want to be sedated”
2. What in an FLAC pain score? For when a patient is resting we use nonverbal pain queues, what is the patient “showing” – grimacing, curled up in fetal position moaning, holding a part of their body, etc”
3. On your form a score of 10 means what? That is a verbal pain score we ask “from 1 to 10 what is your pain” and we write what the patient indicates.
4. Did Beata cause you to “put up a wall” because you felt threatened? Absolutely not, I did not feel threatened, I was more concerned for Maya’s safety. We deal with difficult families all the time.
5. Does “pushing” means forcing the medication into the body? Pushing means giving force to it to give it quickly into the body
6. Same question – it’s not a safe practice and Beata being an infusion nurse herself would have known propofol push was against Florida law for nurses to do.
Mr Anderson
Shows within 48 hours Maya was fine in terms of behavior, right? No, I don’t think Maya was fine in terms of behavior within two days.

There was no more cussing and yelling? I never followed up, but during my shifts she never quit that behavior.

Beata was being pushy. WE deal with that all the time, but not deal with parent asking for dangerous drugs to be “pushed”.

[RVInit]

Jury is dismissed for the day, Judge says there is a motion where plaintiff is requesting an additional 5 hours. (on top of 9 additional hours already given) Judge asks if either side found any case law,.

Defense brings up case law – Sullivan vs Sullivan (?) didn’t catch it all, sorry! They found a couple cases, both said the same thing. He reads it quickly, but it supports what Mrs Crowells said as opposed to what the judge said was his understanding. When time limits are given and one side wants additional time, they have the burden to show how the necessity, wise use of time, etc, all the same stuff Mrs Crowells said. It requires a showing and a proffer of specific need in order to show prejudice. The specific issue in this case was whether or not the plaintiff had preserved the issue for appeal where no such finding of proffer or need was made.

Two other cases – Chillingworth v State 846 So 2nd 674 another 4th district case from 2003, Ketterson v Estate of Bruns 711 So 2nd 13 another 4th district case 1998

That was all they were able to find. There is a federal case or two essentially says the same.

Judge says that is basically what HE said earlier. Mr Hunter is being delicate, sounds more like it’s what Mrs Crowells said earlier. But Hunter is trying to be careful how he says it and just pointing out the actual part where the cases state that to find that an appeal is warranted based on plaintiff not being given more time, they would have had to show that they had used time wisely and made a proffer for what and why they needed the time.

Plaintiff is going to win, sounds like.

Judge: I adjusted the time twice and took away the jury question time so parties aren’t charged with that time. I feel like I adjusted that time accordingly. The question in my mind is over a 7 to 9 week trial have the plaintiff been dilatory with their time. I know I criticized a few times to the plaintiff, but…blah blah blah. Why am I not surprised?

We are looking at a length of time, I think the plaintiff has shown a need, I don’t think they’ve shown much a need. I don’t think there is a pattern of prejudice, so here’s what I’m going to do. It looks like plaintiff has 35 minutes left of 59 hours. I will grant 2.5 additional hours to finish out the defense case. Then 2.5 hours for rebuttal. Now, Mr Anderson, that’s it. I feel like that’s as far as I’m willing to go. If you target your cross exam, let’s say for the sake of argument. If you have any time left of the 2.5 hours of cross exam, you will not be allowed to add that on to your 2.5 rebuttal case. You will only have 2.5 for rebuttal. If you run out the additional 2.5 hours during defense case in chief, that’s it, you are done. You will have to just sit and listen to them ask their questions. Mr Anderson do you understand the severe limitation on time that you have? Yes

Of course, the defense will get an equal amount of additional time, I think that’s fair.

Mr Shapiro is concerned that the defense may run into even Thursday morning for their case now with the additional 2.5 hours of time. (there is no way the defense can possible take up the judge offer of getting an additional 15 hours of time, to make things fair, otherwise it will go to way beyond Wednesday)

He asks what happens if we don’t rest until EOD Wednesday? What if jury needs lawyers during deliberations, most of us scheduled vacations already. This is causing difficulties for everyone and my next trial period. And my family life, too. I feel like I need to grant that additional time. I’m trying to let each time try the case each side thinks they need to try.

[RVInit]

Dr Levy, excellent credentials, published more than 100 peer reviewed articles about addiction

She is an addiction expert, hired back in 2019. (She should have reviewed her report thoroughly prior to testimony. Even though her report is available to the jury, they are going to remember how she came across on the witness stand)

The highlights of her testimony:
She came across well on direct.
She reviewed the treatments Maya was getting, found her to be receiving 100 of times more than typical pain use of ketamine. The younger a person uses addictive drugs, the more likely to get addicted. Also the more often. Maya was both young, and receiving huge doses of ketamine and benzodiazepenes, which are both highly addictive. Ketamine is closely related to PCP, so it has the same addictive qualities. It acts in the pleasure/reward part of the brain which is why it’s addictive, it makes you feel very euphoric as well as being a hallucinogenic drug.

She describes the behavior of someone addicted – anxiety, belligerent, pretty much exactly the behavior Maya demonstrated in the first few days in the hospital.

On cross Mr Whitney was able to get her discombobulated. Once he figured out that she had not memorized amounts and dates, he pinged over and over and over on that. For whatever reason it dodn’t enter her mind to just say “At the time of my review and report I had the exact amounts and dates and I have not committed those to memory”. She just over and over looked like an idiot who didn’t know anything. Ouch. Very bad. She should really have reviewed her own work.

She was fairly well rehabilitated.

One juror question was very sarcastic along the lines of “If ketamine is so bad why is it allowed to be used”. She answered very well. It’s a very good anesthetic and even a good analgesic when it’s not be abused or overused. You don’t throw out perfectly good medications just because some people abuse them. It is a controlled substance, and efforts are made to restrict it’s use, but ultimately it’s up to doctors to use them properly, for the right reason, and in the right amounts according to manufacturer recommendations, which ensure safety.

[RVInit]

They are bringing in a child abuse pediatrician. It is their understanding that the plaintiff is not alleging that the hospital caused any element of damage or seeking damages for any element of suspicion of Munchausen by proxy correct? So I would be able to say in closing argument to the jury that the plaintiff in this case is not seeking damage or alleging that ACH’s suspicion or diagnosis of MBP has caused any damage, is that true?

Mr Whitney says that is an accurate statement of our position.

Mr Shapiro goes on to say that in opening argument, Mr Anderson said we will prove that the false accusation of Munchausen robbed Mrs K of her maternal instinct and caused Mrs K to commit suicide (I remember they said that)

We are running out of witnesses that can rebut that and we need to know for sure if this is something they are going to rebut or claim. We understand the court’s ruling is that you don’t want us to bring up Munchausen. We don’t want to be in a position where they can bring it up during closing or rebuttal after we have no option of putting on another witness. If it’s true that they are not going to argue this, we can limit Dr Alexander to other topics and help save time. They have put a ton of evidence in front of this jury about Munchausen and we have been restricted (hence, the proffer for potential appellate issue by Dr Sally Smith) . They have said that the diagnosis of MBP stopped the transfer to Nemours, caused her to be distraught, all kinds of things. I want clarification from them on what are their intentions, so we can plan our questions for witnesses.

Mr Whitney says “I think both sides are refining positions”. Judge wants a firm answer. Now it’s coming out that if defense argues that it was K family that refused the transfer to Nemours, then we need to be able to bring it up.

[Kriselda Gray]

Jury questions:
1. In interest of ruling out all, when Maya said “I want to be sedated” she was not singing or refereicing a song? No, she was yelling to us she was saying “sedate me, I want to be sedated”

I don't know of too many modern 10-year-old who are familiar with the Ramones

[RVInit]

Defense, Deposition of Ms Sharon O’Leary Johnson – Guardian ad litem office of Sarasota

Developed training programs and training strategies – heavy background and education in Education area. Developed training programs for Frito Lay, Nestle other large companies

Got involved in Texas, Dallas area in Children’s Advocacy. Partially retired because tired of traveling, so she went into Guardian ad litem in Florida in 2014 in Sarasota.

One case at a time. She was Maya’s Guardian ad litem in 2016, 2017. She was asked by manager to take this case as she had finished her last case recently. Jessica Blackrick was her supervisor.

My role was to visit with Maya, talk with her, make observations, make sure her educational needs were met. When a court case, we ask if they want to go, advocate for things like summer camp or things they want to do, tried to get them able to do normal things, try to make that happen. Make sure their environment is safe, make sure they are getting medical or dental treatments.

Enters notes when visiting. She reviewed the notes prior to today. Notes that she wrote in system called Optima. It’s used by Guardian ad litem’s to document their notes.

Visited Maya on a few occasions at the hospital. Any independent recollection? No.

What comes to mind when I say Maya K? A little girl I visited at the hospital who liked her little Shopkins and liked to play the piano.

You took an oath to serve? Yes. What was your understanding of your role? To observe Maya, make sure she was getting her needs met, to advocate for her in court.

First visit notes – GAL 14 – can you view and read? I can read it. Oct 24th? Yes I see that. This is the note I prepared after visit. Does it trigger recollection? Just that she was a nice girl to visit with. What do yu mean? She was talkative, she was welcoming.

She did not look like she was in pain. Right above it also she was smiling and laughing and showing me how her hospital room was organized with her dols in one area and shoes in other area, and where everything was nicely organized. She seemed very happy. Smiling and laughing and there was nothing that I saw that I normally associate with pain.

And then you note a nurse came in to take BP, she made a face and said she didn’t like that because it made her hurt? Yes, I see that

Why did you enter that? Because it’s what I saw.

I saw that her demeanor changed depending on who was in the room. We were just laughing and talking and then all the sudden she changed her demeanor when a nurse walked in.

On GAL 13 appears to be a note from Nov 9, 2016. You start the note by saying Maya was in a lot of pain. She expressed it verbally. We began talking and there was no actual sign of being in pain, she immediately went to acting happy, laughing, smiling after just saying she was in pain.

Maya had her bed, to the right a long couch, she had her Shopkins dolls and toys, makeup stuff next to the bed. Her artwork was hanging on the walls. I observed her playing with her toys, using her hands normally.

Whenever she needed to get around, she moved the wheelchair with her feet or asked me to move the wheelchair. Doesn’t remember how many times she moved the wheelchair on her own, but she did do it.

GAL 12 – I helped her with her shoes, she was very quiet. We were going to go down to play the piano in the lobby. She seemed sad. In general she missed her family. She was playing the piano well and was having a lot of fun doing it. She was pretty good for age 10 playing the piano. Played with both hands and knew some songs.

The piano was in a lobby, we had to use the elevator to go down. She moved herself over using her feet so I could play the piano with her.

Father showed up during this visit. They went back to the room with her father. Mr K brought her toys and presents on this visit. She was excited, she put her new Shopkins on the couch, moved herself around the room by herself using her feet and was untying wrapped presents/Shopkins.

She was very excited and showed no evidence of pain. I included this because she had told me she had pain in the beginning, but I observed that their was no pain evident by any behavior.


The observation of no pain was throughout the entire visit.

Is anything in this report untrue? No

Do you recall helping her put her shoes on? Yes, before I took her to play the piana.

What did the hospital tell you about Maya and her condition? Nothing

(this is Mr Anderson’s voice, he’s frustrated with her because he’s not getting answers he wants) I assume you spoke to somebody at the hospital, one of the nurses or someone about Maya’s condition. No, I did not

And during that conversation they told you something negative about Maya k! No

And during the course of those conversations that Beata was some sort of evil person that was keeping Maya from getting better and that’s why she was there. No

During one of those conversations, you learned that the hospital was trying to demonstrate instances where Maya was not in pain, isn’t that true? No



Do you agree with me that on more than one occasion you noted that Maye id not seem like she was in pain? Yes

And comments like she could move herself? I didn’t say she could roll over. I said she moved herself from her bed to the couch to play with the presents her father gave her and she moved herself at other times as well.

What was the purpose of determining Maya’s best interest? Because my understanding of the shelter order, I was advocating for Maya and I was making observations of what I saw pursuant to the shelter order.

I don’t have medical training. Mr Anderson, my job is to observe what I saw, and note what I saw and advocate for Maya.

(OMG he’s been accusing her of COLLUSION with the hospital staff. What an asshole, and now she’s COLLUDING with everyone else. Maybe when 49 doctors/multiple PT/multiple Psychiatrist/multiple Psychologist, 1 ad litem, 1 child advocate from Child Advocacy are ALL saying the same thing, and Maya’s 2 treating doctors look and sound like quacks, things are exactly as they appear)

My term would be advocate. I am supposed to advocate for Maya. Correct

I advocate for Maya. Not for the hospital or state. I didn’t talk to the hospital. Out of all the interactions with that little girl specifically put that in? Because that is what I saw.

I spent between probably 35 mins to an hour with Maya on each visit. She included all of the activity – moving her wheelchair, unwarping Shopkins, organizing them, laughing, smiling. I noted everything, not just no pain and moving the wheelchair.

I am not an expert on everything, I am reporting what I see. She said she was in pain, but not showing any pain and I felt it was important for my team to see. As far as I know my reports are viewed by my team, not the hospital or anyone else. My team. These are notes I make in OUR system, not outside out system for all to see. Yes, we use a team approach.

The primary goal in all cases is to reunite children with their own family (even if it takes lots of therapy on the part of parents to learn better skills(

How putting all these comments in does that help reunite Maya with family? I don’t know one way or another what the effect of my honest observations are going to be. I wrote what I honestly saw. I wasn’t trying to NOT reunite Maya with her family. I wanted what was best for Maya, I advocate for HER, not the family or the hospital or anyone else.

If we go to Nov 9, “when I asked Maya how she was doing she said she was in pain. Then we started looking at her artwork, Shopkins, and all her activities and she was smiling and giggling and had a great time”. Yes, that is what I observed and wrote.

“She didn’t appear to be in pain”. Yes, I wrote that as well.

How is that reuniting her with her family? To be honest, I don’t know how that comment would affect anything, it was simply my observation. I did not put together pain with reuniting or not reuniting her with family

Maya told me that it wasn’t proper protocol to take blood pressure on an RSD patient. She made a face during the process but once we resumed talking she was ok. (OMG, I am encouraged to take my vitals several times per day. When pain starts getting out of control my pulse can get up to 205, which can cause a heart attack. That is the most common cause of death in an otherwise healthy CRPS patient, when pain gets out of control your pulse goes sky high and you become at risk for heart attack even though you don’t have a heart problem per se. I have to keep track to make sure my pain isn’t getting out of control for a long period where my heart rate will be elevated for hours. It is just plain quackery for any supposed CRPS specialist to tell a patient BP/vitals are not “protocol”. They are the main PROOF that you are having pain. I think that is the issue here. None of her vital signs on any of her medical records indicate a high heart rate. That was one of my earliest tip offs that she doesn’t have this condition, as my heart rate is almost 100 at every doctor visit and all day long. Very close to tachycardia almost all the time, why I have to watch it so closely. Due to high pain level of chronic pain. Which this child did not have any evidence of having)

Mr Anderson is just reading the notes at this point. Maya told this ad litem that CRPS “rain in the family”. (Nobody in my family ever had this. I got it the way most people get it – surgery)

If you googled it you would know what RSD lesions look like. (Not true, try it yourself. You will not find one single thing that looks like Maya’s “CRPS lesions” by googling either RDS lesion or CRPS lesion. Why? Because there is NO SUCH THING)

She keeps telling Mr Anderson the same thing. Her duties are to advocate for the child. The goal is something different. The goal is always to end up eventually with the child back in the home. That is always the goal.

[RVInit]

Dr Windham, Georgetown University,

Allergist and Immunologist (Holy shit, this might be really good. Beata was seeking a diagnosis for immune deficiency)

Board certified in several areas, on teaching staff

No independent recollection of Maya and Beata, all chart driven. Referred by Dr Wassenour, Dr Criseman (pulmonary)

The prescriptions Maya was on were what? Prednisone, caugh meds, he lists a shitload of medications

What are listed as thing that would make Maya worse? Cat, dust, smoke,

Maya was hospitalized just before he saw her. Beata brought her in today for a new “exacerbation of asthma”

They are taliing way too fast. But he’s listing huge amounts of steroids that Maya was taking, liquid, oral, and IV

Daily activities? Gymnastics, ice skating

What you actually observed vs what was reported. 1st visit. What was reason for appointment? Reported symptoms she was dong better, but coughing that day. Mom gave 20 mg predizone. 10 days ago a flare up . She went to hospital next day.

It’s an oral steroid for inflammation. I looked at Kriseman’s note. Kriseman indicated standard of care recommendations.

Any remarkable under social history? No

Describe actual observations – normal, no sign of asthma happening, her skin shoes a history of sczema (these are related to the so called “lesions”) . Not in distress, coherent,

Observed her lungs with stethoscope, clear, no abnormal sounds.

You put in your chart – several allergies, atopic dermatitis, food reaction, conjunctivitis, mild allergic asthma – associated with allergy,

Fur treatment plans – continue inhaled QVar, albuteral as needed.

He observed that her caught sounded like what we call a “habit cough” every 15 seconds in a happy, well appearing girl with normal lung sounds. (If you watch the Netflix special, she does this. It is clearly not caused by actual phlegm or lung problem, sounds fake as can be. When I watched the special with my sister on Saturday my sister laughed when she did this and said “that is a fake cough”)

What is a habit cough? It’s kind of often times self perpetuating, it’s not due to any underlying airway distress. It’s more of an upper airway throat clearing cough.

If you do this enough, it irritates the upper airways and then you do it more and more. But it has nothing to do with lung function.

I will represent to you doctor that other doctors have noted something called a “psychogenic cough” is that the same? Exactly, yes. It’s just a different word for it

It dismisses asthma, I saw no lung pathology, no actual asthma, What I saw was a habit cough.

Happy, well appearing girl. Not in distress, not showing any of the signs that we see in asthma, there is normally distress, muscle movements things that you observe. Nothing there showing asthma. Had a normal spirometer from Dr Kriseman. Breathing test.

I have reviewed previous spirometer readings. What were results? Normal. Pulmonary function test. Asthma can be both normal and abnormal, but usually abnormal.

He noted in his record that “something doesn’t seem right”. He says not that I knew exactly what it was, but the presentation bothered me. I am seeing records from a hospital ER visit for a supposed severe asthma attack and yet the ER testing showed perfectly normal tests, which is simply not what happens with an asthma attack. Then she’s coming to me with another asthma attack this morning, and everything is normal. With the exception of the “habit cough” I saw nothing. Multiple hospital visits with perfectly normal test results but supposed asthma attack.

Beata mentioned that her O2 dropped to 96, and he says that is not any indication of severe or even mild asthma attack. It would be much lower than that. 96 is within normal range for a 10 year old. 96 to 100 is normal.

Recommended reducing medications because of the disconnect between reported and what was observed not just by me, but ER and Dr Kriseman.

Voiding shrimp since four years of age. HPI is information provided by Mom? It’s out interpretation of history taken from parent.

Family reporting information is different from all doctors observations. He notes that even her mother noted 96 O2 but gave her 40 mg prednisone, and two puffs of albuterol. For a perfectly normal o2 reading. Took her to ER but they were busy so she left. That was in his note. Source: family

He says maybe if it’s below 94 you might consider giving prednisone but not 96. He was concerned about the mother’s administration of this medication for even what she said existed. But even his observation s were not nearly what is reported by family.

He used the word “red flag” in his notes multiple times. Says the mother overtreated in his opinion. No symptoms but she’s giving prednisone and other asthma meds.

He reviewed the Venice Regional medical records. Basically she went through triage, had some discussion of pain. In throat 8 out of 10. Behavior is anxious. The only objective eval were vital signs. Pulse elevated, O2 100. Not in red zone or any zone.

They left after 24 mins because it was taking too long. Hospital noted only a “cough”. Her lungs were clear from exam and her O2 was 100% meaning she was getting full oxygen, it doesn’t get better than 100. This was a visit for “severe asthma attack”. But they left after 24 minutes because “it was taking too long”.

New visit note: No nocturnal awakenings were happening. She wasn’t using albuterol recently. Same as previous. She had skin tests positive for trees, Bermuda grass, mold, cat, dog, cockroach. Allergic to a few things.

Oadk, bayberry, birch, family history of allergies, which is common. Disappointed to learn she was on a high dose of steroids for an entire week after she last left my office, starting that very night. I don’t like anybody getting sick, and I had noted everything perfectly normal.

Further note: I have advised mom not to use steroids when O2 is 96 or above. She was receiving serious treatment for numbers that are in the normal range. Her parents were arguing about taking her to the ER, so family dynamics might play a role here. Dad did not want to take her to ER.

Allergy shots would be an option. Allergy immunology is allergy shots. No follow up with that. They did not proceed with recommendations for allergy shots. I never saw her for two more years.

(this is not surprising to me after seeing this much testimony. Beata wouldn’t treat with relatively mild treatment recommendation for actual symptoms, but treated for “severe asthma” with no evidence of having asthma ever being seen by a doctor in office or ER.)

At next visit he finds out she’s been in a wheelchair for two years, weak legs, and had RSD diagnosis.

Lungs clear, skin clear, vital signs perfectly normal. Active eczema. He noted that she remained on a large amount of meds in spite of doing so well. His exam showed no issues at all. He again recommended to cut back on the asthma medication, steroids.

Recommended follow up in one year, cut meds. He never saw her again after this. (Interesting. After the visit where he said she’s fine, cut meds, doesn’t come for 2 years. Then again same thing, ever saw her again. But she’s getting meds from a different doctor)

Every visit indicated normal lung function. They go over several bronchial sound tests designed to determine if any blockage. Every one was normal on every visit. In short this doctor never found evidence of asthma, bronchitis, or any actual breathing/lung issue.

They go over all the details, she is well above normal in every single one.

She did not follow recommendations for cutting meds (per Beata own reporting) or recommendation for allergy shots.

Did JHACH ask about your interaction with family? No

[RVInit]

Jury questions:
1. In interest of ruling out all, when Maya said “I want to be sedated” she was not singing or refereicing a song? No, she was yelling to us she was saying “sedate me, I want to be sedated”

I don't know of too many modern 10-year-old who are familiar with the Ramones

Just put me in a wheelchair, put me on a plane. I wanna be sedated

[RVInit]

[RVInit]

The defense is arguing that Maya got on that witness stand and told this jury that her entire life is destroyed because of what the hospital did to her. We have been prohibited from showing that she’s having the normal life of a teenager. She went to prom, she goes out with friends, she has a boyfriend, she went to new York to go to the film festival. She put all these photos on social media herself to show the highlights of her life. The jury has heard nothing in this courtroom except how awful her life is.

He read from case law.

The judge allows the plaintiff to whine and complain. He ends up allowing only two photos that were both from a single “night out”.

Defense indicates they will do another appellate proffer. This will be the third one, as they did one Friday, one earlier today, and now going to do another one at some point. I think they are fed up with this judge pulling the rug out from under their case. Part of what this jury is going to be determining is how much this hospital ruined Maya’s life by “interrupting” her treatment. The defense is not being able to show that Maya clearly, according to her own social media pages, is living a full and fun teenage life and has been doing so since leaving the hospital.

[RVInit]

Dr Dolan – JHACH anesthesiologist, board certified in anesthesia and pain management

The first encounter of Maya by anyone from the pain management team was the Nurse Practitioner of Dr Dolan. When Dr Dolan reviewed those notes she thought her NP had made a mistake in noting Maya’s treatment. She confirmed with NP that this is what the family actually told her. She called Dr Hanna and spoke directly to him.

Dr Hanna confirmed the meds he had given her the day before and that he was uncomfortable giving her any more felt like his treatment had failed and he sent her to ACH. She was alarmed as these would be normally toxic, almost lethal doses.

She thought maybe there is something I don’t know, she conferred with two previous colleagues who she knew were exceptionally well respected in the area of pain management and they also confirmed that her instincts were on target, they had never heard of ketamine being used in a child like this before, and they were both familiar with pediatric CRPS. After conferring with them, she did further research through literature to see if she could find any mention at all of using ketamine like this in apediatric patient.

The first time she saw May in person she was very pale, large dark circles around her eyes, she was in the middle of the bed, with her mother by her side. She was trembling, she was screaming, angry, crying, she was not consolable. Sometimes she was like in a rage. It was a very dramatic scene. The communication with the family was difficult at that time.

Exhibit – history of present illness/pain assessment. She’s reading it to herself first. Mentions most of the above, plus Hr Hanna admits that she needed higher and higher doses and he cannot get her reported pain down. She mentions hearing about the “ketamine coma”. The mother also mentioned she wanted an inrathecal clonidine pump. It’s a device placed surgically into the space at the center of the central nervous system. The idea is that it puts medication directly into the spinal fluid that flows to the brain. There are serious risks for this. If infection gets in, it goes straight to the brain. An overdose is possible. It’s a foreign body so the body tries to reject it. That obstructs the flow of spinal fluid.

We don’t recommend it and we don’t do it here. She would have to find someone else to do it. She offered, reluctantly, to help her find a place to do that for her.

A short term and long term treatment plan were devised.

Short term, acute pain treatment. She complained of severe generalized pain. Not eating or drinking for 4 or 5 days. She was displaying signs of anxiety, withdrawal and drug toxicity. So we needed to deal with all three things. And also needed to stabilize her.

Acute pain – we discussed with parents and PICU and we came up with a plan. To treat her pain and withdrawal we used a lower dose of ketamine, normal range, propofol was for the agitation, precede is also an analgesic that helps with pain and also is used to treat withdrawal symptoms.

Long term pain basis – the plan was for PT/OT/CBT. Did Mrs K respond at all to your plan to include psychiatric type therapies. She got upset, actually both of them got very upset, they used foul language and told her “we are not crazy, we don’t need that”. I told her I don’t believe you are crazy, you are living with a reported chronic condition, and you and your family need a coping mechanism to help with this process. (This is exactly why people who are diagnosed with psychological conditions, which normally are caused by chemical imbalance, do not accept treatment - because everyone wants to substitute the word “crazy” for psychological conditions. The fact that an RN doesn’t understand that psych does not mean “crazy” makes me totally unimpressed with Beata’s knowledge of medicine. Thank goodness I never needed an infusion nurse from the company she worked for)

My understanding was outside diagnosis of CRPS. We treated her as such. We accepted that outside diagnosis. This is day 1 she was admitted.

After Oct 7 did you treat her a few days later? Yes, on Sunday, Oct 9. She ws doing better, more calm, able to talk, able to perform an exam. I saw she was doing better. She wasn’t agitated, not restless, didn’t have the palpitations. The first day she said she thought she was dying and going to have a heart attack. On Sunday, she was completely different. We were able to see a typical 10 year old. She was still getting ketamine and Precedex. The weaning plan was from the very beginning, Oct 7.

To progressively go down from the medications. Because she had developed a tolerance and dependence. When stopped suddenly the patient wants that medication. That’s what we saw on Oct 7.

The weaning schedule in her Oct 9 note is exactly what they had discussed. Mr K was present, Mrs K was over the phone. Both parents agreed to the weaning plan. At a certain point, Dr Dolan had learned that she had not eaten or drank on her own for 5 days.

There is a note in the record that says that Maya had not eaten in 5 days. The nurse practitioner asked if she had no appetite and Maya said “No, I’m not allowed to eat”. (I think what she is talking about is that Dr Hanna was giving her amounts of ketamine that would knock her out. We saw one photo from that and she was clearly totally unresponsive in that photo. Mouth open, out cold. And his treatments were always four day treatments. I believe he was basically doing a ketamine coma, but the family is not admitting or telling anyone that. Mention has been made about how he had no adequate records kept. Her not eating for four to five days matches that Maya had just been through a four day treatment from Dr Hanna, probably completely knocked out)

I knew she wasn’t eating or drinking, I knew she had severe abdominal pain and if you ask me what I remember from that day, I remember sitting at the nurse station and she was all excited that Maya wanted to eat a donut.

She was far more comfortable and that’s why I noted it. She wanted to eat, Her behavior was totally different. Note says tomorrow we will begin the weaning. Note about preparing for transfer to Nemours

She knew the mom was interested in going to Orlando, I also provided the family with a list of resources for treatment of CRPS. We didn’t have the resources for the amount of PT and amount of psych services she needed for a chronic pain condition. I agreed with the transfer to Nemours. The propofol was only for 4 hours, never given after.

Dr Dolan told the family that we would not be escalating the medications. During Oct 9 she observed her physically. No dystonia. Nothing consistent with allodynia. After Oct 9 she saw her Nov 1. Were other members of ACH pain team attending Maya during days that Dr Dolan wasn’t attending her. There were four pain doctors as the 5th one was on maternity leave. Oct 12 or 13 she got Haldol on three occasions. Used in ICU settings and we use it specifically for agitation. Also for withdrawal. She only got 3 doses in 48 hours. It was a bridge used during weaning process. The wean had been completed for ketamine at that time.

Haldol used as a bridge. We are weaning her from medications, they can show symptoms (sidebar)

(The plaintiff has made a huge deal of the use of Haldol as if the hospital was hopping her up on it. This is the first we are hearing only three single doses were given in a single 48 hour period and never given again. Plaintiff not happy right now I’m sure)

After the sidebar they are showing the record showing when Haldol was given on Oct 12. At 2:46 PM given for agitation. Another given Oct 12 at 8:35 PM for agitation, 1 mg each time. On Oct 13 4 AM 1 mg for agitation. No other administration of Haldol in Maya’s chart at any time.

Nov 1 visit – She has a recollection of her visit. Maya was sad, missing her family. I asked her how can I help her, can I make it better. She wanted to interact with kids her own age. I called Child Life and asked them to please try to involve Maya in any activity they could find for her. Her functionality was different. Even though she was sad, her vitals were normal, no distress, she could do activities and wanted to do them.

Nov 2 visit Dr Dolan found Maya had been participating in many activities in the Activity Center and Child Life was finding lots of things for Maya to do. She was very active in games and arts and crafts, playing piano, etc.

Very little of pain medication she was getting at this point. PT/OT.Psych support.

Nov 4 – Maya making progress with mood, participation in activities and PT

Nov 15 – She did not want to talk to me, she was solemn. She told me she did not want to talk to me anymore. Her lawyer told her that we were all lying to her and that I was not giving her the right treatment and that I was not giving her the RDS treatment or the IV infusions.

I never lied to Maya K. I was giving her proper therapy for her pain condition

Nov 29, 2016 – she made a note about the importance of parents participating in any chronic pain therapy.

Back to Dr Hanna treatment. She understand what Dr Hanna was doing. Did you have a chance to look at his actual records at a later date? Yes (previously she only talked to him on the phone)

What did you come to learn about his infusion on Oct 6th? Objection (Hanna lied to her about giving the infusion over 4 hours, they were actually given over 2 hours according to his own deposition.) Judge obviously sustained the objection, so jury won’t know that the doctor that gave Maya the most of her ketamine treatments lied to another doctor about at least one of those treatments)

She is being asked now about ACH policy on ketamine infusion. Sidebar

Is death from pulmonary embolus slow? No. (Dr Kirkpatrick who only actually saw Maya 3 times testified that Maya would die a slow death at the hands of ACH because she wasn’t being given her ketamine)

Sustained objection
Whitney doing cross. He’s as big an asshole as Anderson. Not once has a defense witness raised their voice or used sarcasm in cross exam. These two are sarcastic and angry with cross exams

Did I hear you testify that Maya did not receive propofol after Oct 7? Not to my recollection

Exhibit. Propofol on Oct 8 – she wants to explain, Whitney says no (It’s because it was used for 4 hours starting on the 7th very late in the evening, carried over to the 8th)

Oct 13 used as part of her general anesthesia because she had a procedure. It was not used for pain treatment or weaning again.

Oct 14 – another general anesthesia event. For different purposes

You have been the corporate representative for the hospital several times during this trial. How many days? I’m not sure, maybe 4 (they have a doctor in the court every day)

Sidebar. Which witness testimony did you observe? Dr Cantu, Neuropsych from Tampa, Dr Hanna video, Dr Kirkpatrick

Not here with Dr Elliot. Did not discuss his testimony. She is on committees. As of 2016 was on the medical executive committee – she knows she was on that committee at one time, but doesn’t remember the exact dates of that.

He’s reading names of different doctors. Objection, relevance. Sidebar (Oh, let me guess how the judge will rule on this one. Insert eyeroll emoji here)

He continues reading doctor names. She says no, not here for any of these testimonies. Dr Cavit, Krisema. She says yes I know I was on that committee, I didn’t remember the years.

5 doctors were on the committee during Maya’s stay in the hospital. How many times had Maya been an inpatient? I don’t know, this was my only time I ever encountered her that I remember. I knew at least once, but not how many times. She was there 16 times as an outpatient. I saw her on Oct 7 for the first time as far as I remember.

Bylaws showing the duties and responsibilities of the Medical Committee. One function is liaison between the hospital and CEO.

He’s badgering her about her notes vs her recollection. I don’t remember if I entered a note about Maya using profanity. (others have said they don’t put things like that in notes) he’s now asking her lots of things that don’t get put in notes.

Plan was to wean her off her meds and discharge next week. I wasn’t attending during that time period when she was originally planned to have been discharged. She was not aware security was notified (they weren’t, they never called security on the family, that is bald faced lie)

Sidebar, Whitney is trying to cross exam her on someone else’s notes.

She says correct, Maya used profanity. It was part of my observations. We did not take her off medications or ignore her pain because of her cussing. Because she cussed hospital can observe her for 48 hours. What is so important about Maya using profanity. It was part of my observation of that day.

He says hospital retaliated against Maya for 97 days because she cussed. Judge tells him to stop that line of question.

On the first day she was in the room with Maya for 4 hours. How many hours in 3 months. Probably at least 35 mins on subsequent encounters. Approx 7 hours. Not a psychologist or psychiatrist.

Now he is flat out laying that she had been receiving CBT from Eagle’s Wings. They never claimed to give her CBT.

Dr Dolan reiterated that the treatment Maya needed was not possible at ACH. They had limited ability to deliver the amount of PT/OT/CBT that she needed. That is why Dr Dolan recommended her to go to Nemours, who had a program.

The final decisions about treatment included Dr Dolan with the other members of the treatment team in PICU.

Dr Dolan says she took the outside CRPS diagnosis seriously and treated her pain as such. Over time she had doubts, she saw inconsistencies, but she treated her pain as such.

She doesn’t remember the exact day Beata committed suicide. Dr Dolan was supposed to testify in some hearing, and she received a phone call telling her she didn’t need to come. Then, later she received an email about Mrs K suicide.

Did the Medical Executive committee ever discuss Beata’s suicide? No, but we were not treating the mother.
How long Maya K wean happen? Approx 5 to 7 days

The use of propofol? Explain the use of that? It’s a pure anesthetic medication. When used Oct 7 why used? To control her agitation. We started in the middle of the night of the 7th and finished on the 8th. 4 hours

Maya had an endoscopy because of her abdominal pain to help diagnose.

Can yelling and screaming be a sign of withdrawal? Yes
Jury questions
1. You spent 3 hours with Maya and family on your first visit. Did you not follow up with the family on what treatments Maya had had prior to coming to the hospital? Yes, I did, and the response was the ketamine treatments, but nobody told her anything about Eagle nest or anything other than the ketamine treatments. They rely on the family to tell them otherwise they don't know who to reach out to.
2. Formal training in CRPS prior to treating Maya? It’s a big part of training for general anesthesia doctors. It’s a condition that Anesthesiologist/pain management doctors usually diagnose and treat. It’s much more frequent in adults. In pediatric it’s much more uncommon. But enough that we do see it
3. How many CRPS patients have you treated before Maya? Maybe 7 or 8 per year. We had two other patients overlapping with Maya at the same time. Now, we have a specific CRPS program we see 3 to 4 per month because we get them from all over

[RVInit]

Deposition – Paola Padron –

Atlanta GA. Worked for ACH. Dec 2017 left – child abuse coordinator.

Not a management position.

The end.
2nd depo of same witness

During time you saw Maya over 3 month period, did you see her acting like an abnormal child, faking injuries, faking things, acting strangely? I personally did not

Did you have to work on Christmas? We were often on call and I wouldn’t be surprised if it says I worked that day.

Dec 23 2016 Action taken/Intervention completed – This worker dropped off Maya’s dresses that were dropped off by her family. Maya showed excitement at receiving the new dresses. May was smiling and happy at this time. She was very happy and was holding them up to look at them.

Don’t remember any other interaction with Maya. I don’t recall the details of Christmas for her. I don’t remember visits or anything.

Were you trying to inflict emotional distress on her? No

Nobody indicated that ever wanted to inflict emotional distress on her? No

Any reason to believe that anyone wanted to inflict emotional distress on maya? No

Was Cathi Bedy trying to inflict emotional distress on Maya? No

[RVInit]

The defense is showing the jury one of many emails that Beata sent to herself. In these bizarre emails she writes them in "Maya's voice" as if it was Maya writing them. They are long. She is describing a "CRPS relapse". Once again, just proving to me she doesn't have it and that her doctors are quacks.

She makes an interesting observation that "this time the abdominal pain isn't as bad as usual". What is significant about that is that the day before Dr Hann told her mother to take her to ACH emergency room he had given her the largest dosage of ketamine over the shortest period of time ever. And she ended up with massive abdominal pain. That is actually what they said she was in ER for. But it quickly turned to "treat her with a ketamine coma" for CRPS. The whole ER interaction was bizarre.

This email also documents that Dr Hanna wrote prescriptions for oral ketamine to be used at home.

She mentions cupcakes and cappucino. Two of the worst things you can do for chronic pain is load up on sugar or load up on caffeine. So, this 10 year old with supposedly the worst pain condition known is drinking cappuccino and eating cupcakes all day. Every time they ever mention food it's always chocolate cake, donuts, or cupcakes. This girl eats nothing but sweets.

She says she was better after about the 3rd day of the ketamine booster and can move herself around in her wheelchair and scoot around on the floor now.

Well, if this is what she considers "good" they have a mountain to climb in proving the hospital made her worse.

[RVInit]

Another one of these "Maya's voice" emails written by Beata. A month later documenting how much worse she is, "I told my mommy I needed my IV ketamine NOW" "Oral ketamine is the worst tasting stuff ever"

OMG it goes on and on. " I want to die" all kinds of stuff like this. Again, how the fuck can this family live with themselves trying to get millions from the hospital for "making Maya worse". She's talking here about wanting to die".

honestly, I doubt she wanted to die. She wanted attention. She exhibits so much exaggeration.