Dr Sally Smith – she has super impressive credentials, was more friendly than I expected
She is one of the two people that the plaintiffs are demonizing. I saw aboslutly nothing in her testimony to support any of the plaintiff demonizing. Nothing regarding any of the child abuse case is allowed to be talked about here. Based on the things that have slipped in, I see why they wanted to demonize her because she reminded me of Dr Mendez, who was one of Maya’s treating physicians for only two visits. Beata never went back to him again because he didn’t “play ball” and give her the immune deficiency diagnosis for Maya that she was looking for. Dr Sally Smith reminded me of him in the respect that she collected all of Maya’s doctor records and identified at least three (that I know of) diagnosis that Beata sought for Maya, two of which she successfully obtained harmful treatment for Maya.
I only know about that from listening to attorney/judge discussions about what comes in what stays out. The jury is hearing NONE of that. Which is a shame because the hospital would have a slam dunk case if it did. Instead, I believe it is highly likely the plaintiff will win this case. And at this point I now believe that Beata committed suicide because she knew that Dr Sally Smith, as Director of Medicine with the Child Protection Team was doing a full investigation of Maya’s medical history and if she was anything close to competent would find that Beata had sought diagnosis for severe asthma, enough to obtain large amount of steroids (which caused Maya steroid myopathy and likely to be the reason her legs got weak enough to end up in the wheelchair), she went to three different immunologists attempting to get Maya a diagnosis for immune deficiency (take a gander at the kind of treatment for that, none of these attempts were successful), and then she succeeded in getting a diagnosis for CRPS after doing research on the internet, visiting the quack at the CRPS ketamine treatment center and obtaining that diagnosis and a huge number and amount of ketamine treatments for her daughter. Dr Smith concluded that Beata likely had Munchausen by proxy, seeking , and even obtaining, treatments for conditions she didn’t have. I’m guessing that she was easily able to convince a doctor that Maya had severe asthma because the doctor knew that she was a nurse and (s)he didn’t really look into it. Two different doctors later independently confirmed that at most she might have mild asthma, but probably not asthma at all. One of those ironically was JHACH, and they determine that more than a year before her final visit that resulted in the lawsuit.
I don’t know why any of this is not coming in. So, the jury knows NONE of this stuff. All they know is some sweet little girl had massive pain and the big bad wolf took her treatment away from her.
I will write up the details of Dr S Smith testimony in a little bit. I hope. Maybe.
Taking Care of Maya - FL CPS/Munchausen case
Taking Care of Maya - FL CPS/Munchausen case
There's a lot of things that need to change. One specifically? Police brutality.
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Sam the Centipede
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Taking Care of Maya - FL CPS/Munchausen case
Thanks RV, and others. It's interesting to read your comments on the decisions by the judge about what testimony/evidence is permitted and what never reaches the jurors' ears.
I'm no lawyer, but if you're correct that the exclusion might mislead testimony the jury to a verdict in favor of the plaintiffs, then there would be grounds for an appeal, yes?
Professional people who convey a sense of trustworthiness and sound plausible can create great harm when they abuse that power.
I'm no lawyer, but if you're correct that the exclusion might mislead testimony the jury to a verdict in favor of the plaintiffs, then there would be grounds for an appeal, yes?
Professional people who convey a sense of trustworthiness and sound plausible can create great harm when they abuse that power.
Taking Care of Maya - FL CPS/Munchausen case
Ok, I'm trying to catch up a bit here. First, I am floored at the level of Ketamine this little girl was given. I'm 5'6 and weigh 140 and only had 100 MG per hour and she was getting 1500??? That is just insane. And mom's demand for a 1500 mg bolus? Jesus, I get a 5mg at the beginning of my infusions to kick me off and they really kick me off. I don't know how this kid survived all this plus all the other meds she was on. I cannot believe the 2 docs that gave her all these meds, I guess they are quacks or were just trying to get rid of this patient.
A lot of what Sally Smith was going to testify to is ruled out because on a short period time time is before the jury apparently. The Ks are suing for actions, or allegations, that took place outside the family court orders. Seems to have caused jury some confusion so Judge read the family court orders to give them a time line.
A lot of what Sally Smith was going to testify to is ruled out because on a short period time time is before the jury apparently. The Ks are suing for actions, or allegations, that took place outside the family court orders. Seems to have caused jury some confusion so Judge read the family court orders to give them a time line.
Taking Care of Maya - FL CPS/Munchausen case
Dr Sally Marie Smith , pediatrician. Partner in a practice in Sarasota, private practice
she has super impressive credentials
She brought a huge number of binder
Georgetown University BS in biology, lots more, too much to type, did a large amount of training so she could teach, was interested in child abuse pediatrics from early in her residency, in medical school she did a rotation with medical examiner who had her review all the cases of child abuse that resulted in death
In late 80’s there was no fellowship training in child abuse pediatrics, so most of that training is hand-on, she took a faculty position at ACH and she requested to work with CPT team and they allowed her to gain a lot of experience seeing all of the child abuse cases at that time
In 2009 was the first time child abuse pediatrics became something you can get board certified, she qualified to sit for the exam because of the amount of time, experience, and a recommendation to take the exam. She took the exam in fall 2009 and early Jan got notification of passing the exam
CPT Pinellas County – she was already working with CPT while on staff at ACH, and when the Medical Director for Pinellas County retired in 2002, they asked her if she would take the position, as she had the most experience in the County . She couldn’t do both, so she resigned ACH position and became the Medical Director for CPT for Pinellas County
It’s about a 20-26 hour a week job as Med Director for Pinellas Cty, so she started working part time in the medical practice where she still works, now full time, today
She was Med Director when she saw Maya in 2016 and had been in that position since 2002 and no longer was employed by ACH.
CPT team for each county, included NP, physicians, social workers (case coordinator) team psychologist, attorney, Medical Director. They are required to evaluate any suspected case of child abuse, medical or otherwise. Most of the time they are called in by CPI at DCF. The CPT is under the Dept of Health in Florida so they work side by side with DCF, we help them investigate their case by looking at the medical side of it and whether child safety is at risk.
What is role of CPT and Med Dir – to provide the medical evaluation. It varioes as to how much work is required to do that. We end up being a go between with attorneys, law enforcement, court, CPI, everyone who may be involved. To assist everyone with medical advice. We present in court, assist juries with information they may need, and educate doctors with how to recognize possible child abuse.
If a child is sheltered, there are some cases where she may need to consult especially in more complex cases
In fall 2016 what other hats did you wear? I worked in the private practice working half time. Since 1990 had medical staff privileges at ACH, and medical providers have to have credentialing to see their own patients that are in the hospital. As a community pediatrician I was well known to medical staff and they ask her to be representative on some of their committees for several hospitals
In fall 2016 she had medical staff privileges at Bayfront and JHACH, also had private practice patients that sometimes would be in the hospital.
(Sidebar. She comes across as exceptionally professional)
In oct 2016 she received a call from Dr Teppa Sanchez. She had never heard of Maya k. Dr Teppa called her about concerns that she had. I talked to her on the phone, she was asking about a possible case of Munchausen by proxy. I talked to her about the kinds of things that were needed to assess that kind of situation, what to look for in medical records, and briefly about the specific case. I tried to give general advice as to how pediatricians can approach questions about MBP or what I prefer to call medical child abuse.
Were yu called as a member of CPT or medical staff member or do you know? My understanding is that I was being called because I had previously been on staff and I was the person that was always known as the one who worked with the child abuse cases and that I had expertise in that area. She was seeking my advice
I believe I briefly accessed the medical records at that time. I did not take any steps to make arrangement to assess Maya or exam her in any way. As the M Director I have to be asked by CPI to step into the case officially. This was just a consult from a fellow doctor who had a concern and was seeking advice. There was no actual investigation ongoing gyet, and Dr Teppa Sanchez can’t directly ask me to get involved in an actual investigation.
On Monday the CPT was asked to get involved. I took no action on Maya at all between the phone call and Monday morning when we were officially brought in to an investigation.
Were you advised of an investigation and asked to conduct a medical exam as the Med Dir of CTP. Yes, that is the time that I became involved in my part of the investigation. I was acting as a Medical Director of CPT. Because I as involved in a medical practice as well, I had privileges at the various hospitals, so I was more easily able to review records than some of the other members of the team, but I was doing my job as a member of the Child Protection Team and not as a “consulting physician”.
She was in PICU at the time that I became involved. I don’t get involved in any day to day management of the patient care at all, I am not on the patient care team. I am called in to do a physical exam of any child involved in a child abuse case and do not direct the care of the child at all.
The exam of the child is part of my statutory duties. The physicians that are treating are obviously going to helped if they have access to all the data that I may gather if it has to do with her medical care. I do provide my medical report, if they ask for it. A physician who is logged in could see the CTP report and utilize it for that time the child is in the hospital or subsequent visits, but it Is not even available until I complete the report, finish, review, and sign it.
This is not the same as a “consult”. So, there is never a “consult order” from a hospital physician. Typically it’s a social worker at the hospital that makes a report to the hotline and eventually we get involved. I never wrote a progress report, never wrote an order, did not participate in “rounds” . I saw Maya one time in October and I think one time in November. Those were the only two times I ever saw her
Part of the medical evaluation is supposed to be a physical evaluation. In October I tried and she declined. So, I went back in November to do the exam. I am also supposed to take some photographs. I did not end up taking any photographs.
As part of the medical examination I took an extensive history from Mrs K and a more abbreviated history from Mr K. Oct 11 was Mrs K and met with Mr K on Oct 13. The meeting took place in the family conference room at PICU. Because of the investigation was happening, I scheduled a time when the law enforcement and CPI could join while I was taking the history. So, there were about 5 people total in the meeting.
I identified myself to Mrs K. I say I am Sally Smith I am a pediatrician with the Child Protection Agency
I was not wearing a lab coat. I wear a JHACH name badge because I need that badge to enter rooms, it’s a key card. I have one from Bayfront as well.
I was not an employee of JHACH and never told Mrs K that I was acting on behalf of JHACH. This was scheduled and everyone knew what this meeting was about and was going to take place. Everyone was in the room when I got there, and I think some of them had already interviewed her. There were 2 law enforcement officers and 2 of the other CPT team members, so I can’t see how Mrs K could have had any confusion about who I was and why I was there. Everyone in the room was involved in the investigation.
I was there about 1.5 hours. I spoke with Mr K two days later. I don’t remember the time. That meeting lasted about 10 or 15 minutes. The bedside nurse was there, Mr K and Maya were present. I identified myself to Mr K the same way I always did. I never told Mr K that I was working on behalf of JHACH I always say the same thing “I’m Sally Smith, I am a pediatrician with Child Protection Services”. I do not wear a lab coat, but I do wear a badge issued by JHACH. When I go to Bayfront I wear a badge issues by Bayfront. Those are issued to all members of CPT not just because I happen to also have privileges at those hospitals as a practicing pediatrician.
I was wearing street clothes, similar to what I am wearing today. Were you aware of any efforts being made to transfer Maya to another institution? I think I found out about it, but I don’t know when I found out. I was not involved in that effort. I did not direct that. I did not direct any of Maya’s care. I know there was an interdisciplinary staff meeting and I had multiple discussions that I had with the treating physicians and I know one of them told me.
I did not know they were weaning her from her medications. At some point in my investigation I determined that as part of the abuse aspect that I wanted certain medications removed to verify that they were unnecessary, and when I reached out I found out they already had started weaning and had only one medication left that she was still being given. I learned that from communication with the attending physician.
As part of my statutory duties I follow any part of the course of the patient care that is or may be involved with the medical abuse. This was a very lengthy process, I wasn’t done with the report by then
Exhibit – Email from Cathi Bedy. Did you ask her to arrange a meeting for you to mee with the treatment team? Yes, at that time there was going to be a meeting with the dependency attorneys and there was a need to present to the judge what options he could choose from and I needed information from the treatment team.
(sidebar – plaintiffs asking for a lot of sidebars on this witness, she is not sounding at all like she did anything untoward, her answers are direct, she’s not hesitating. Sometimes she needs to think about an exact date, but she’s not consulting notes or anything. So far there is nothing that sound at all unreasonable to me. I think the whole “problem” with her is that she collected quite a bit of evidence of medical child abuse and the plaintiff doesn’t like her for that)
She never was a member of the medical team actually treating Maya in the hospital.
Plaintiff
Has testified over 399 times in court.
She never met with Mr Hunter, mever had an email, never had a phone call. Not one communication with the defense team ever prior to testifying. Her attorney from Suncoast Center Insurance communicated when and where she needed to be.
She is still working in the same pediatric partnership, now she is full time. She resigned from Pinellas County as Medical Director a few months ago - July.
She’s in Pediatric practice? Yes
JHACH doesn’t have a child protection team, but residents have child abuse training at some point and I was the medical director in charge of child abuse training so I was involved in training some of the JHACH residents on child abuse as I trained other residents at other hospitals. They came to the center where I taught, I did not teach in JHACH for child abuse. He’s being sarcastic that now she’s in charge of residents.
Exhibit – she is not a pediatric psychiatrist, not a pian specialist, not an anesthesiologist. But you were included in this treatment team. No
Bottom paragraph. I was involved only as the Medical Director CPT – there were aspects of her medical care involved in child abuse, so I was involved or kept informed of those areas. Medications for Maya were part of her job because those medications were part of the abuse. So, to a small degree that is why I was involved.
Yes, I recommended to get her off all those medications because I saw no medical reason for those in her records. And they already were taking her off of them – they already had the opinion that she didn’t need those. So, by the time I made the recommendation, they were already doing it.
I received some of her lab results because some of her lab results were alarming, and as Medical Director I suspected medication being given unnecessarily might be involved. So, I wanted to have the results of labs after her medications were weaned.
Mr Anderson badgers her throughout the cross exam. She is getting the better of him, she is not getting flustered.
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? Would that be child abuse? She’s very cool and says she doesn’t know what he’s talking about. He’s getting himself more upset trying to get her upset.
There is a progress note from Dr Dees that mentions a meeting that she and other members of the treating team had with Sally Smith. He’s trying to use this to prove that she’s ON the treating team. She’s telling the jury this is a progress note by the attending physician. She is noting things that SHE did or she participated in. One of the things she participated in was a meeting with Dr Smith.
She explains the HIPAA regulation exception that allowed her to access Maya’s records when a fellow physician called her initially when she wasn’t sure whether she was seeing a case of medical child abuse.
Redirect
Was your access of the records because you were being asked for a “consult”? Yes
Customary? Yes
CPT duties – part of your statutory requirements are to follow a sheltered child? It depends, in this case it was complex, so to an extent
I believe I heard your name, but never met you ..Never discussed this case.
--------------------------------------------------------------------------------------------
Jury Questions
The judge is asking her these questions outside the presence of the jury. This is interesting because this took place after the jury sent in their questions, he asks them to leave the room if there are mor than just a couple questions. So, they left the room, then he has the witness leave the room. Then he goes over the questions with attorneys to see if they have objections to the questions. They spent a huge amount of time going over the questions, way over the amount for any other witness. Then the judge wanted to bring in the witness to ask her a couple of questions before the jury comes back in. That hasn’t ever happened before. (I suspect that at least one juror is doing research and at least reading comment sections about this case. There is a great deal of demonizing of Dr sally Smith and Cathi Bedy in comment sections even though neither of them has been presented as witnesses until today)
1. Did you have any converstion with Bonnie Rice about Maya K? When? – Oct/Nov 2016
2. Any discussion with Bonnie Rice in calendar year 2015 about Maya K? no
Jury questions
Usually the judge asks the obligatory questions about talking to someone, seeing media, etc, really fast. This time he is looking at each juror and asking very slowly the questions about have you talked to anyone about this case…have you seen any media reports about this case….etc. He is asking these questions super earnestly for some reason. See my suspicion above. Ther was one previous time where a juror asked a question that made me think someone on the jury is researching, watching, looking at commentary about this case.
1. Have you had a conversation with Bonnie Rice from TGH about Maya? Yes (How the hell would a juror even know to ask this question, this explains the above suspicion I have, I’m typing my thoughts as I have them, so I am floored right now.)
2. When approx. was that conversation? Late Oct/early Nov 2016
3. Have you had conversations with ARNP Bonnie Rice about Maya in 2015? No
4. Do you know why it is the hospital policy to contact you first instead of reporting first to the child abuse hotline? (that wasn’t the testimony) It’s not usual. Because of the way Florida is set up, sometimes they are not sure what to do, on occasional situations, like once or twice a year, a doctor at ACH would call me to ask me a question and request my expertise related to the question they had
5. Correct me if I am wrong, there is no harm in contacting the hotline prior to contacting an expert first. The only situation would be if there potentially wasn’t really enough to justify a report, or it’s right on that line. But almost all the time the report gets made before I get a call from CPT to get involved.
6. Would CPT normally access the medical records? I would always access them as an active member of the medical staff, for members of CPT that don’t have that access, they would have to submit a request for the records and get them that way
7. Does the county CPT have access to medical records normally without privileges? Not electronic access, they would make a request and the hospital is required to provide them
8. Are the physicians that are part of CPT that do not have privileges at a hospital allowed to make an assessment? Yes, mine is easy, but other teams, like Miami, I think the Medical Director has to have privileges to actually see the child, but I’m not sure because I did have privileges, so that didn’t apply to me.
9. If yes, do the privileges grant access to the medical records? Yes, we have to be re-credentialled every year
10. Is it standard for a CPT physician to offer recommendations to the treating physicans as part of a child abuse case? With regard to certain tests or certain needs of the court, yes. For example if I’m seeing a child that has a bunch of injuries and a brain scan is needed, I can ask the treating team if they can order a brain scan to be performed by a certain date. And typically they will do it because it’s for the purposed of the investigation.
11. Who made the referral to your CPT for the evaluation? Our coordinator calls the person who is on call (I think she misunderstood, they probably want to know who at ACH made the call). The CPI calls the CPT and they take the information and they call me and tell me to go see the child
12. When you told Dr Dees to get Maya off as many meds as possible, did you know that was already in progress? No
13. Do you still have medical privileges at JHACH? Yes
Given how short a list of questions, I am now really surprised at how long the judge and attorneys discussed the questions. I do believe it has to do with suspicion that a juror is doing research.
Follow up
Exhibit – This is an email from Beata dated 10/12/2016 – midway through paragraph she says she had a “super sixed “ meeting for 1.5 with child protective services
She never say the EEG video
Were you aware of anything about Maya defecating or urinating on herself? No
she has super impressive credentials
She brought a huge number of binder
Georgetown University BS in biology, lots more, too much to type, did a large amount of training so she could teach, was interested in child abuse pediatrics from early in her residency, in medical school she did a rotation with medical examiner who had her review all the cases of child abuse that resulted in death
In late 80’s there was no fellowship training in child abuse pediatrics, so most of that training is hand-on, she took a faculty position at ACH and she requested to work with CPT team and they allowed her to gain a lot of experience seeing all of the child abuse cases at that time
In 2009 was the first time child abuse pediatrics became something you can get board certified, she qualified to sit for the exam because of the amount of time, experience, and a recommendation to take the exam. She took the exam in fall 2009 and early Jan got notification of passing the exam
CPT Pinellas County – she was already working with CPT while on staff at ACH, and when the Medical Director for Pinellas County retired in 2002, they asked her if she would take the position, as she had the most experience in the County . She couldn’t do both, so she resigned ACH position and became the Medical Director for CPT for Pinellas County
It’s about a 20-26 hour a week job as Med Director for Pinellas Cty, so she started working part time in the medical practice where she still works, now full time, today
She was Med Director when she saw Maya in 2016 and had been in that position since 2002 and no longer was employed by ACH.
CPT team for each county, included NP, physicians, social workers (case coordinator) team psychologist, attorney, Medical Director. They are required to evaluate any suspected case of child abuse, medical or otherwise. Most of the time they are called in by CPI at DCF. The CPT is under the Dept of Health in Florida so they work side by side with DCF, we help them investigate their case by looking at the medical side of it and whether child safety is at risk.
What is role of CPT and Med Dir – to provide the medical evaluation. It varioes as to how much work is required to do that. We end up being a go between with attorneys, law enforcement, court, CPI, everyone who may be involved. To assist everyone with medical advice. We present in court, assist juries with information they may need, and educate doctors with how to recognize possible child abuse.
If a child is sheltered, there are some cases where she may need to consult especially in more complex cases
In fall 2016 what other hats did you wear? I worked in the private practice working half time. Since 1990 had medical staff privileges at ACH, and medical providers have to have credentialing to see their own patients that are in the hospital. As a community pediatrician I was well known to medical staff and they ask her to be representative on some of their committees for several hospitals
In fall 2016 she had medical staff privileges at Bayfront and JHACH, also had private practice patients that sometimes would be in the hospital.
(Sidebar. She comes across as exceptionally professional)
In oct 2016 she received a call from Dr Teppa Sanchez. She had never heard of Maya k. Dr Teppa called her about concerns that she had. I talked to her on the phone, she was asking about a possible case of Munchausen by proxy. I talked to her about the kinds of things that were needed to assess that kind of situation, what to look for in medical records, and briefly about the specific case. I tried to give general advice as to how pediatricians can approach questions about MBP or what I prefer to call medical child abuse.
Were yu called as a member of CPT or medical staff member or do you know? My understanding is that I was being called because I had previously been on staff and I was the person that was always known as the one who worked with the child abuse cases and that I had expertise in that area. She was seeking my advice
I believe I briefly accessed the medical records at that time. I did not take any steps to make arrangement to assess Maya or exam her in any way. As the M Director I have to be asked by CPI to step into the case officially. This was just a consult from a fellow doctor who had a concern and was seeking advice. There was no actual investigation ongoing gyet, and Dr Teppa Sanchez can’t directly ask me to get involved in an actual investigation.
On Monday the CPT was asked to get involved. I took no action on Maya at all between the phone call and Monday morning when we were officially brought in to an investigation.
Were you advised of an investigation and asked to conduct a medical exam as the Med Dir of CTP. Yes, that is the time that I became involved in my part of the investigation. I was acting as a Medical Director of CPT. Because I as involved in a medical practice as well, I had privileges at the various hospitals, so I was more easily able to review records than some of the other members of the team, but I was doing my job as a member of the Child Protection Team and not as a “consulting physician”.
She was in PICU at the time that I became involved. I don’t get involved in any day to day management of the patient care at all, I am not on the patient care team. I am called in to do a physical exam of any child involved in a child abuse case and do not direct the care of the child at all.
The exam of the child is part of my statutory duties. The physicians that are treating are obviously going to helped if they have access to all the data that I may gather if it has to do with her medical care. I do provide my medical report, if they ask for it. A physician who is logged in could see the CTP report and utilize it for that time the child is in the hospital or subsequent visits, but it Is not even available until I complete the report, finish, review, and sign it.
This is not the same as a “consult”. So, there is never a “consult order” from a hospital physician. Typically it’s a social worker at the hospital that makes a report to the hotline and eventually we get involved. I never wrote a progress report, never wrote an order, did not participate in “rounds” . I saw Maya one time in October and I think one time in November. Those were the only two times I ever saw her
Part of the medical evaluation is supposed to be a physical evaluation. In October I tried and she declined. So, I went back in November to do the exam. I am also supposed to take some photographs. I did not end up taking any photographs.
As part of the medical examination I took an extensive history from Mrs K and a more abbreviated history from Mr K. Oct 11 was Mrs K and met with Mr K on Oct 13. The meeting took place in the family conference room at PICU. Because of the investigation was happening, I scheduled a time when the law enforcement and CPI could join while I was taking the history. So, there were about 5 people total in the meeting.
I identified myself to Mrs K. I say I am Sally Smith I am a pediatrician with the Child Protection Agency
I was not wearing a lab coat. I wear a JHACH name badge because I need that badge to enter rooms, it’s a key card. I have one from Bayfront as well.
I was not an employee of JHACH and never told Mrs K that I was acting on behalf of JHACH. This was scheduled and everyone knew what this meeting was about and was going to take place. Everyone was in the room when I got there, and I think some of them had already interviewed her. There were 2 law enforcement officers and 2 of the other CPT team members, so I can’t see how Mrs K could have had any confusion about who I was and why I was there. Everyone in the room was involved in the investigation.
I was there about 1.5 hours. I spoke with Mr K two days later. I don’t remember the time. That meeting lasted about 10 or 15 minutes. The bedside nurse was there, Mr K and Maya were present. I identified myself to Mr K the same way I always did. I never told Mr K that I was working on behalf of JHACH I always say the same thing “I’m Sally Smith, I am a pediatrician with Child Protection Services”. I do not wear a lab coat, but I do wear a badge issued by JHACH. When I go to Bayfront I wear a badge issues by Bayfront. Those are issued to all members of CPT not just because I happen to also have privileges at those hospitals as a practicing pediatrician.
I was wearing street clothes, similar to what I am wearing today. Were you aware of any efforts being made to transfer Maya to another institution? I think I found out about it, but I don’t know when I found out. I was not involved in that effort. I did not direct that. I did not direct any of Maya’s care. I know there was an interdisciplinary staff meeting and I had multiple discussions that I had with the treating physicians and I know one of them told me.
I did not know they were weaning her from her medications. At some point in my investigation I determined that as part of the abuse aspect that I wanted certain medications removed to verify that they were unnecessary, and when I reached out I found out they already had started weaning and had only one medication left that she was still being given. I learned that from communication with the attending physician.
As part of my statutory duties I follow any part of the course of the patient care that is or may be involved with the medical abuse. This was a very lengthy process, I wasn’t done with the report by then
Exhibit – Email from Cathi Bedy. Did you ask her to arrange a meeting for you to mee with the treatment team? Yes, at that time there was going to be a meeting with the dependency attorneys and there was a need to present to the judge what options he could choose from and I needed information from the treatment team.
(sidebar – plaintiffs asking for a lot of sidebars on this witness, she is not sounding at all like she did anything untoward, her answers are direct, she’s not hesitating. Sometimes she needs to think about an exact date, but she’s not consulting notes or anything. So far there is nothing that sound at all unreasonable to me. I think the whole “problem” with her is that she collected quite a bit of evidence of medical child abuse and the plaintiff doesn’t like her for that)
She never was a member of the medical team actually treating Maya in the hospital.
Plaintiff
Has testified over 399 times in court.
She never met with Mr Hunter, mever had an email, never had a phone call. Not one communication with the defense team ever prior to testifying. Her attorney from Suncoast Center Insurance communicated when and where she needed to be.
She is still working in the same pediatric partnership, now she is full time. She resigned from Pinellas County as Medical Director a few months ago - July.
She’s in Pediatric practice? Yes
JHACH doesn’t have a child protection team, but residents have child abuse training at some point and I was the medical director in charge of child abuse training so I was involved in training some of the JHACH residents on child abuse as I trained other residents at other hospitals. They came to the center where I taught, I did not teach in JHACH for child abuse. He’s being sarcastic that now she’s in charge of residents.
Exhibit – she is not a pediatric psychiatrist, not a pian specialist, not an anesthesiologist. But you were included in this treatment team. No
Bottom paragraph. I was involved only as the Medical Director CPT – there were aspects of her medical care involved in child abuse, so I was involved or kept informed of those areas. Medications for Maya were part of her job because those medications were part of the abuse. So, to a small degree that is why I was involved.
Yes, I recommended to get her off all those medications because I saw no medical reason for those in her records. And they already were taking her off of them – they already had the opinion that she didn’t need those. So, by the time I made the recommendation, they were already doing it.
I received some of her lab results because some of her lab results were alarming, and as Medical Director I suspected medication being given unnecessarily might be involved. So, I wanted to have the results of labs after her medications were weaned.
Mr Anderson badgers her throughout the cross exam. She is getting the better of him, she is not getting flustered.
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? Would that be child abuse? She’s very cool and says she doesn’t know what he’s talking about. He’s getting himself more upset trying to get her upset.
There is a progress note from Dr Dees that mentions a meeting that she and other members of the treating team had with Sally Smith. He’s trying to use this to prove that she’s ON the treating team. She’s telling the jury this is a progress note by the attending physician. She is noting things that SHE did or she participated in. One of the things she participated in was a meeting with Dr Smith.
She explains the HIPAA regulation exception that allowed her to access Maya’s records when a fellow physician called her initially when she wasn’t sure whether she was seeing a case of medical child abuse.
Redirect
Was your access of the records because you were being asked for a “consult”? Yes
Customary? Yes
CPT duties – part of your statutory requirements are to follow a sheltered child? It depends, in this case it was complex, so to an extent
I believe I heard your name, but never met you ..Never discussed this case.
--------------------------------------------------------------------------------------------
Jury Questions
The judge is asking her these questions outside the presence of the jury. This is interesting because this took place after the jury sent in their questions, he asks them to leave the room if there are mor than just a couple questions. So, they left the room, then he has the witness leave the room. Then he goes over the questions with attorneys to see if they have objections to the questions. They spent a huge amount of time going over the questions, way over the amount for any other witness. Then the judge wanted to bring in the witness to ask her a couple of questions before the jury comes back in. That hasn’t ever happened before. (I suspect that at least one juror is doing research and at least reading comment sections about this case. There is a great deal of demonizing of Dr sally Smith and Cathi Bedy in comment sections even though neither of them has been presented as witnesses until today)
1. Did you have any converstion with Bonnie Rice about Maya K? When? – Oct/Nov 2016
2. Any discussion with Bonnie Rice in calendar year 2015 about Maya K? no
Jury questions
Usually the judge asks the obligatory questions about talking to someone, seeing media, etc, really fast. This time he is looking at each juror and asking very slowly the questions about have you talked to anyone about this case…have you seen any media reports about this case….etc. He is asking these questions super earnestly for some reason. See my suspicion above. Ther was one previous time where a juror asked a question that made me think someone on the jury is researching, watching, looking at commentary about this case.
1. Have you had a conversation with Bonnie Rice from TGH about Maya? Yes (How the hell would a juror even know to ask this question, this explains the above suspicion I have, I’m typing my thoughts as I have them, so I am floored right now.)
2. When approx. was that conversation? Late Oct/early Nov 2016
3. Have you had conversations with ARNP Bonnie Rice about Maya in 2015? No
4. Do you know why it is the hospital policy to contact you first instead of reporting first to the child abuse hotline? (that wasn’t the testimony) It’s not usual. Because of the way Florida is set up, sometimes they are not sure what to do, on occasional situations, like once or twice a year, a doctor at ACH would call me to ask me a question and request my expertise related to the question they had
5. Correct me if I am wrong, there is no harm in contacting the hotline prior to contacting an expert first. The only situation would be if there potentially wasn’t really enough to justify a report, or it’s right on that line. But almost all the time the report gets made before I get a call from CPT to get involved.
6. Would CPT normally access the medical records? I would always access them as an active member of the medical staff, for members of CPT that don’t have that access, they would have to submit a request for the records and get them that way
7. Does the county CPT have access to medical records normally without privileges? Not electronic access, they would make a request and the hospital is required to provide them
8. Are the physicians that are part of CPT that do not have privileges at a hospital allowed to make an assessment? Yes, mine is easy, but other teams, like Miami, I think the Medical Director has to have privileges to actually see the child, but I’m not sure because I did have privileges, so that didn’t apply to me.
9. If yes, do the privileges grant access to the medical records? Yes, we have to be re-credentialled every year
10. Is it standard for a CPT physician to offer recommendations to the treating physicans as part of a child abuse case? With regard to certain tests or certain needs of the court, yes. For example if I’m seeing a child that has a bunch of injuries and a brain scan is needed, I can ask the treating team if they can order a brain scan to be performed by a certain date. And typically they will do it because it’s for the purposed of the investigation.
11. Who made the referral to your CPT for the evaluation? Our coordinator calls the person who is on call (I think she misunderstood, they probably want to know who at ACH made the call). The CPI calls the CPT and they take the information and they call me and tell me to go see the child
12. When you told Dr Dees to get Maya off as many meds as possible, did you know that was already in progress? No
13. Do you still have medical privileges at JHACH? Yes
Given how short a list of questions, I am now really surprised at how long the judge and attorneys discussed the questions. I do believe it has to do with suspicion that a juror is doing research.
Follow up
Exhibit – This is an email from Beata dated 10/12/2016 – midway through paragraph she says she had a “super sixed “ meeting for 1.5 with child protective services
She never say the EEG video
Were you aware of anything about Maya defecating or urinating on herself? No
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Attorneys go to bench – Jury leaves the room and judge tell Dr Sally Smith there is going to be a proffer
Proffer:
Defense:
This is a proffer for a potential appellate record. I’m going to ask you some kind of conclusory questions and summary questions.
In the process of your investigation of the Maya K case did you conduct an investigation? Yes
Did you promulgate two different reports? Yes, one was a preliminary report – Oct 18 and one Dec 2, 2016? Yes
Did both reports indicate your investigation and conclusion as of those dates? Yes
Did you obtain certain medical records? Yes
Fairly and accurately reflect the records you had gathered up to that date? Yes
Subsequently did you receive additional information? Yes
Does your report of Oct 18 fairly and accurately reflect up to that date? Yes
Would it also reflect the facts that you provided to the court up to that date? Yes
Exhibit being marked for ID: Is that a true and correct copy of your report of Oct 18? Yes
After that report from Oct did you continue the investigation as reflected in December? Yes, I received many more records after the October report
Exhibit – Does your Dec 2, 2016 report also reflect your opinion and conclusions as of that date? Yes
Briefly give this court your conclusion as of that report: It was my conclusion that there were positive findings for medical child abuse and the medical record review provided strong evidence to support that conclusion.
Was that conclusion be colloquially known as Munchausen syndrome by proxy? Yes, and I believe I even reference those words as being the “former” term for Medical Child Abuse.
Did you reach any conclusion about conversion disorder? Yes
What was that? It was my conclusion based on all of the observations of the various staff team and multiple other physicians reports that she had conversion disorder. It’s actually called FND – Functional Neurologic Disorder now.
(Well I don’t normally say “I told you so”, but I’m gong to say way back on this topic I had mentioned that what I was seeing very much seemed like it went along these lines and that everything seemed to point to this. )
In reaching these conclusions and opinions you just gave us, how many pages of medical records did you review? I don’t know exactly but well over 2,000
I see you brought about 5 5-inch binders, are those some of the records you reviewd? Thos are all of the records I reviewed. (She drug out a shitload of binders from her bags when she first sat down.) She says these are all the ones I printed, but I reviewed some record electronically and did not print them out. Everything that I had copy of going back to her very first pediatrician visit in Chicago is in these binders.
Did the material you reviewed include certain online Wordpress blogs written by Beata Kowolski? Yes
Mr Anderson
Right at the start of this you had a call with Dr Kirkpatrick? I did
Dr K explained to you that he had been treating Maya K for CRPS? He did
And he told you that CRPS is often mistaken for conversion or Munchausen by proxy. I don’t remember exactly what his words were, I took a few notes from the conversatin I had with him and it was something along those lines
And yet you did not put anything in your report about Dr Kirkpatrick did you? Yes, I believe there is a whole section about his medical records
Except for the fact that you did not tell anyone in that report that he had warned you off of going after the Kowolskis. It’s completely irrelevant for a CPT report. I gathered every single record from Maya’s history directly from her doctors. The problem in these cases is that the treating physicians have not done that and so the fact that he, who sent her to Mexico for that ketamine coma, told me not to investigate child abuse is completely irrelevant to me because my job was to investigate possible medical child abuse. So, if I was to come away from my job and say “this doctor told me not to, so, I’m not going to do it and there is no evidence of anything here” I would not be doing my job even remotely near a standard of care.
Do you not understand the importance of putting both sides of the story in your report? The both sides of the story is the responsibility of the various people who were going to present it to the court. My job bas Medical Director of CPT is to assist the investigators and attorneys in the case as to if there is evidence to support a determination of whatever type of child abuse is being assessed. So it’s not my responsibility to lay out a whole other argument of what it might be if I have extensive evidence to support a determination that this is a type of child abuse.
You know there wasn’t a single child psychologist or child psychiatrist that diagnosed what you were claiming. That is also irrelevant to my report
So you are the ultimate decider of medical issues which you have minimal or no training in. I have extensive training in evaluating child abuse in the medical field. Medical child abuse is a pediatric medical diagnosis. There is a parallel track in psychiatry where there is a thing called factitious Disorder which is assessing the perpetrator or the caretaker in that scenario. But I don’t need a psychiatric degree to assess medical child abuse. I am very well trained to evaluate medical child abuse based on my child abuse pediatrics experience and board certification.
Well, there’s not a single child psychologist or psychiatrist that agreed with you, you do realize that. No I don’t.
Well, name a child psychologist or child psychiatrist that examined Maya K who agreed with you. Well, that wasn’t their job to write in their report that Maya was a victim of medical child abuse. So that exact thing documented by Dr Cavitt or Dr Kassenstein I don’t know what they wrote or if they ever wrote that as one of their diagnosis, but that’s not their job. My job is to assess whether there is sufficient support for a diagnosis of medical child abuse I present that evidence to the court. The court can decide whether and how to act on that. So, the court has every ability to pull all these other people like psychologists, psychiatrists and any other person playing a role in evaluating their part in it, including Dr Kirkpatrick, including Dr Hanna, and I think they did testify in the dependency action. And if the judge decides that there is serious question about whether I’m right then the court makes that decision based on the evidence that they receive. That’s not my job to litigate the whole thing in my report. It’s not my place to say I’m the child abuse pediatrician, but here is everyone else’s view as well. I have my part and I am convinced that there was medical child abuse in this case.
So, you did not put in any of the conclusions or any of the data from Eagle’s Wings, those were the psychologists that saw the Kosolskis, did you? There was a licensed clinical social worker intern who saw Maya and her family at Eagle’s Wings and I don’t honestly know where that was in the pile of records when I was writing up my report. I did inadvertently not include Eagle’s Wings in my report.
Well, you did research it enough to know that Rebecca Johnson had a Master’s Degree and over 20 years experience as a therapist, did you not? Well, the question about my part….I just asked if you knew or not. I don’t recall her exact credentials, I will take your word for it, but it’s irrelevant. Unless she did what I did and reviewed everything from every medical doctor, reviewed all the medical records and had requisite medical knowledge about medical child abuse. For her to be able to say one way or the other whether there was medical child abuse she would need to have those particular credentials and do a complete review of Maya’s medical history.
(He’s getting nowhere with her. Her experience testifying is showing. She’s not cowed one bit by his aggressive questioning. He may be looking for his balls by the time she’s finished with him)
OK, look, did anybody agree with your assessment that there was no CRPS. Yes, I believe they did.
Who? Multiple people on the Hospitalist team that believed she didn’t have it, I believe there were some question about that she might have some kind of amplified pain disorder, the entire pain management team did not think she had CRPS.
Well, amazingly enough we had Dr Elliot in here and he never said she did not have it (I think he did say it was more likely she did not have it)
None of the doctors testified that they were experts in CRPS or that she did not have it. I wasn’t supposed to watch any of the testimony, so I don’t know what they testified to.
From your investigation though, did it come to your attention that nowhere in any of the records did anyone who had any expertise in this, that is a pain management doctor, a neurologist, an anesthesiologist ever agree with your assessment that there was no CRPS. Yes, I believe there were numerous people that did not believe she had CRPS
Did you check with Dr Spiegel, a board certified Neurologist (I never heard of a neurologist diagnosing this. When you feel like you are on fire you go to a pain management doctor, not a neurologist. It is very rare for a neurologist to treat or diagnose CRPS) Dr Spiegel had this 10 year old child do hyperbaric chamber sessions I think 40 days in a row, when she also got ketamine on some of the same days. I wasn’t terribly worried about whether he thought or didn’t think she had CRPS
Regarding Dr Hanna, I put his information in the history. I agree he diagnosed her, but this is a man who was giving a 10 year old child, a small malnourished child, huge doses of ketamine, Versed, magnesium in an outpatient setting, all at the same with no documentation of vital signs and there were indications in the records that appeared to me to suggest that the family member was the person who was monitoring the pulse occimeter. So, this doesn’t seem like a doctor that is particularly reliable in terms of whether this child needed the treatment she was getting or whether he made an accurate diagnosis or not. So, I put his information in my report and yes, I discounted his diagnosis.
Dr Cantu never sent me any records, so I could not address that information except for what I got from a WordPress blog. This person put a 9 year old child in a ketamine coma for days. It took at least a week for her to be able to be discharged from the hospital after that. I didn’t find him reliable from what I saw.
I don’t know more about CRPS, but I looked at how they were treating her and did not find their opinion to be reliable.
Who elected you judge? No one. I presented the information to a real judge who made a determination using not only my information, but all these others people had opportunities to present theirs as well.
He accuses her of being a medical prosecutor rather than a medical investigator. She says no. She presents her findings and the other side get to present theirs as well, they can bring in whoever they want and the judge makes a decision. They have five attorneys on their side, we have one. They presented al these doctors and a judge has to try to made his determination and decide which witnesses have credibility
I am not an investigator or prosecutor, I am a medical doctor who has a great deal of experience and board certification in medical child abuse.
The judge steps in and tells Mr Anderson that he has given him wide latitude and it’s time to stop
Asks Mr Hunter if he has anything else.
I think I already knew that Kirkpatrick hadn’t seen Maya in 20 months.
All the previous hospitals were previous t 2016, did any of them suggest CPRS? No, and many of them were highly competent to diagnose CRPS
Proffer Complete
Proffer:
Defense:
This is a proffer for a potential appellate record. I’m going to ask you some kind of conclusory questions and summary questions.
In the process of your investigation of the Maya K case did you conduct an investigation? Yes
Did you promulgate two different reports? Yes, one was a preliminary report – Oct 18 and one Dec 2, 2016? Yes
Did both reports indicate your investigation and conclusion as of those dates? Yes
Did you obtain certain medical records? Yes
Fairly and accurately reflect the records you had gathered up to that date? Yes
Subsequently did you receive additional information? Yes
Does your report of Oct 18 fairly and accurately reflect up to that date? Yes
Would it also reflect the facts that you provided to the court up to that date? Yes
Exhibit being marked for ID: Is that a true and correct copy of your report of Oct 18? Yes
After that report from Oct did you continue the investigation as reflected in December? Yes, I received many more records after the October report
Exhibit – Does your Dec 2, 2016 report also reflect your opinion and conclusions as of that date? Yes
Briefly give this court your conclusion as of that report: It was my conclusion that there were positive findings for medical child abuse and the medical record review provided strong evidence to support that conclusion.
Was that conclusion be colloquially known as Munchausen syndrome by proxy? Yes, and I believe I even reference those words as being the “former” term for Medical Child Abuse.
Did you reach any conclusion about conversion disorder? Yes
What was that? It was my conclusion based on all of the observations of the various staff team and multiple other physicians reports that she had conversion disorder. It’s actually called FND – Functional Neurologic Disorder now.
(Well I don’t normally say “I told you so”, but I’m gong to say way back on this topic I had mentioned that what I was seeing very much seemed like it went along these lines and that everything seemed to point to this. )
In reaching these conclusions and opinions you just gave us, how many pages of medical records did you review? I don’t know exactly but well over 2,000
I see you brought about 5 5-inch binders, are those some of the records you reviewd? Thos are all of the records I reviewed. (She drug out a shitload of binders from her bags when she first sat down.) She says these are all the ones I printed, but I reviewed some record electronically and did not print them out. Everything that I had copy of going back to her very first pediatrician visit in Chicago is in these binders.
Did the material you reviewed include certain online Wordpress blogs written by Beata Kowolski? Yes
Mr Anderson
Right at the start of this you had a call with Dr Kirkpatrick? I did
Dr K explained to you that he had been treating Maya K for CRPS? He did
And he told you that CRPS is often mistaken for conversion or Munchausen by proxy. I don’t remember exactly what his words were, I took a few notes from the conversatin I had with him and it was something along those lines
And yet you did not put anything in your report about Dr Kirkpatrick did you? Yes, I believe there is a whole section about his medical records
Except for the fact that you did not tell anyone in that report that he had warned you off of going after the Kowolskis. It’s completely irrelevant for a CPT report. I gathered every single record from Maya’s history directly from her doctors. The problem in these cases is that the treating physicians have not done that and so the fact that he, who sent her to Mexico for that ketamine coma, told me not to investigate child abuse is completely irrelevant to me because my job was to investigate possible medical child abuse. So, if I was to come away from my job and say “this doctor told me not to, so, I’m not going to do it and there is no evidence of anything here” I would not be doing my job even remotely near a standard of care.
Do you not understand the importance of putting both sides of the story in your report? The both sides of the story is the responsibility of the various people who were going to present it to the court. My job bas Medical Director of CPT is to assist the investigators and attorneys in the case as to if there is evidence to support a determination of whatever type of child abuse is being assessed. So it’s not my responsibility to lay out a whole other argument of what it might be if I have extensive evidence to support a determination that this is a type of child abuse.
You know there wasn’t a single child psychologist or child psychiatrist that diagnosed what you were claiming. That is also irrelevant to my report
So you are the ultimate decider of medical issues which you have minimal or no training in. I have extensive training in evaluating child abuse in the medical field. Medical child abuse is a pediatric medical diagnosis. There is a parallel track in psychiatry where there is a thing called factitious Disorder which is assessing the perpetrator or the caretaker in that scenario. But I don’t need a psychiatric degree to assess medical child abuse. I am very well trained to evaluate medical child abuse based on my child abuse pediatrics experience and board certification.
Well, there’s not a single child psychologist or psychiatrist that agreed with you, you do realize that. No I don’t.
Well, name a child psychologist or child psychiatrist that examined Maya K who agreed with you. Well, that wasn’t their job to write in their report that Maya was a victim of medical child abuse. So that exact thing documented by Dr Cavitt or Dr Kassenstein I don’t know what they wrote or if they ever wrote that as one of their diagnosis, but that’s not their job. My job is to assess whether there is sufficient support for a diagnosis of medical child abuse I present that evidence to the court. The court can decide whether and how to act on that. So, the court has every ability to pull all these other people like psychologists, psychiatrists and any other person playing a role in evaluating their part in it, including Dr Kirkpatrick, including Dr Hanna, and I think they did testify in the dependency action. And if the judge decides that there is serious question about whether I’m right then the court makes that decision based on the evidence that they receive. That’s not my job to litigate the whole thing in my report. It’s not my place to say I’m the child abuse pediatrician, but here is everyone else’s view as well. I have my part and I am convinced that there was medical child abuse in this case.
So, you did not put in any of the conclusions or any of the data from Eagle’s Wings, those were the psychologists that saw the Kosolskis, did you? There was a licensed clinical social worker intern who saw Maya and her family at Eagle’s Wings and I don’t honestly know where that was in the pile of records when I was writing up my report. I did inadvertently not include Eagle’s Wings in my report.
Well, you did research it enough to know that Rebecca Johnson had a Master’s Degree and over 20 years experience as a therapist, did you not? Well, the question about my part….I just asked if you knew or not. I don’t recall her exact credentials, I will take your word for it, but it’s irrelevant. Unless she did what I did and reviewed everything from every medical doctor, reviewed all the medical records and had requisite medical knowledge about medical child abuse. For her to be able to say one way or the other whether there was medical child abuse she would need to have those particular credentials and do a complete review of Maya’s medical history.
(He’s getting nowhere with her. Her experience testifying is showing. She’s not cowed one bit by his aggressive questioning. He may be looking for his balls by the time she’s finished with him)
OK, look, did anybody agree with your assessment that there was no CRPS. Yes, I believe they did.
Who? Multiple people on the Hospitalist team that believed she didn’t have it, I believe there were some question about that she might have some kind of amplified pain disorder, the entire pain management team did not think she had CRPS.
Well, amazingly enough we had Dr Elliot in here and he never said she did not have it (I think he did say it was more likely she did not have it)
None of the doctors testified that they were experts in CRPS or that she did not have it. I wasn’t supposed to watch any of the testimony, so I don’t know what they testified to.
From your investigation though, did it come to your attention that nowhere in any of the records did anyone who had any expertise in this, that is a pain management doctor, a neurologist, an anesthesiologist ever agree with your assessment that there was no CRPS. Yes, I believe there were numerous people that did not believe she had CRPS
Did you check with Dr Spiegel, a board certified Neurologist (I never heard of a neurologist diagnosing this. When you feel like you are on fire you go to a pain management doctor, not a neurologist. It is very rare for a neurologist to treat or diagnose CRPS) Dr Spiegel had this 10 year old child do hyperbaric chamber sessions I think 40 days in a row, when she also got ketamine on some of the same days. I wasn’t terribly worried about whether he thought or didn’t think she had CRPS
Regarding Dr Hanna, I put his information in the history. I agree he diagnosed her, but this is a man who was giving a 10 year old child, a small malnourished child, huge doses of ketamine, Versed, magnesium in an outpatient setting, all at the same with no documentation of vital signs and there were indications in the records that appeared to me to suggest that the family member was the person who was monitoring the pulse occimeter. So, this doesn’t seem like a doctor that is particularly reliable in terms of whether this child needed the treatment she was getting or whether he made an accurate diagnosis or not. So, I put his information in my report and yes, I discounted his diagnosis.
Dr Cantu never sent me any records, so I could not address that information except for what I got from a WordPress blog. This person put a 9 year old child in a ketamine coma for days. It took at least a week for her to be able to be discharged from the hospital after that. I didn’t find him reliable from what I saw.
I don’t know more about CRPS, but I looked at how they were treating her and did not find their opinion to be reliable.
Who elected you judge? No one. I presented the information to a real judge who made a determination using not only my information, but all these others people had opportunities to present theirs as well.
He accuses her of being a medical prosecutor rather than a medical investigator. She says no. She presents her findings and the other side get to present theirs as well, they can bring in whoever they want and the judge makes a decision. They have five attorneys on their side, we have one. They presented al these doctors and a judge has to try to made his determination and decide which witnesses have credibility
I am not an investigator or prosecutor, I am a medical doctor who has a great deal of experience and board certification in medical child abuse.
The judge steps in and tells Mr Anderson that he has given him wide latitude and it’s time to stop
Asks Mr Hunter if he has anything else.
I think I already knew that Kirkpatrick hadn’t seen Maya in 20 months.
All the previous hospitals were previous t 2016, did any of them suggest CPRS? No, and many of them were highly competent to diagnose CRPS
Proffer Complete
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
I just put two entries for Dr Sally Smith. She was a very good witness for the defense. The plaintiff got nothing from her except probably two bruised balls that might need medical attention. She kicked his sarcastic ass.Maclilly wrote: ↑Thu Oct 26, 2023 2:40 pm Ok, I'm trying to catch up a bit here. First, I am floored at the level of Ketamine this little girl was given. I'm 5'6 and weigh 140 and only had 100 MG per hour and she was getting 1500??? That is just insane. And mom's demand for a 1500 mg bolus? Jesus, I get a 5mg at the beginning of my infusions to kick me off and they really kick me off. I don't know how this kid survived all this plus all the other meds she was on. I cannot believe the 2 docs that gave her all these meds, I guess they are quacks or were just trying to get rid of this patient.
A lot of what Sally Smith was going to testify to is ruled out because on a short period time time is before the jury apparently. The Ks are suing for actions, or allegations, that took place outside the family court orders. Seems to have caused jury some confusion so Judge read the family court orders to give them a time line.
The second entry for Dr Smith is a proffer. I believe the defense is going to appeal this case based on the judge leaving out all the stuff about Munchausen. He has allowed the plaintiff to repeatedly accuse the hospital of accusing Beata of MBP, but he will not allow the hospital to enter any evidence that shows they were well within their rights to believe MBP was going on.
Also, from her proffer I am gathering that the dependency hearing was likely going to result in Maya being separated from her mother on a more permanent basis. I think from the proffer I can see the reason the plaintiffs hate her so much is that the judge likely found her to be more credible than the quacks that diagnosed CRPS and filled Maya with ketamine and other drugs. She is lucky to be alive.
This might also be part of why Beata committed suicide. I hope the hospital drags the K family through appellate hell if they win anything from this jury. If the jury heard that testimony that was proferred, I think that would turn the case on it's head.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
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pipistrelle
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Taking Care of Maya - FL CPS/Munchausen case
Well, isn't that a leading question, with the assumption of the motive "so she would urinate on herself."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?
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 $$$ in her eyes. On her "good days."
Taking Care of Maya - FL CPS/Munchausen case
My understanding of a proffer is where the evidence is being presented in front of the judge without any jury usually for some decision making purposes. Usually when I see this it has to do with something that is profferred for the current judge to decide if the currently jury can hear all or part of it.pipistrelle wrote: ↑Thu Oct 26, 2023 6:31 pmWell, isn't that a leading question, with the assumption of the motive "so she would urinate on herself."He’s asking her the same as he asks every witness about were you part of the decision to put the commode out of her reach or make the nurses move slowly so she would urinate on herself?
I'm not sure I know what preferred testimony is but I don't get why the idea of a suspicion of medical child abuse isn't allowed as a lot of the boxes were checked.
I suspect Maya the near adult has $$$ in her eyes. On her "good days."
In this case the explanation was it's a proffer for potential appeal. Her testimony that was profferred ws not allowed in front of the jury, but is crucial for the defense. They want her testimony that was denied by this judge to be put on the record I believe so an appellate court can make a determination if leaving it out was unfair to the defense, hence, they win their appeal. If the plaintiff gets awarded on any of the counts that this testimony would have defended, then they will appeal.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
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Tiredretiredlawyer
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Taking Care of Maya - FL CPS/Munchausen case
Good description of a proffer.
"Mickey Mouse and I grew up together." - Ruthie Tompson, Disney animation checker and scene planner and one of the first women to become a member of the International Photographers Union in 1952.
Taking Care of Maya - FL CPS/Munchausen case
There are so many knowledgeable lawyers on this forum and I try to read and understand what you IAALs have to say. I think a teeny tiny bit might have rubbed off on me.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
[Also, from her proffer I am gathering that the dependency hearing was likely going to result in Maya being separated from her mother on a more permanent basis. I think from the proffer I can see the reason the plaintiffs hate her so much is that the judge likely found her to be more credible than the quacks that diagnosed CRPS and filled Maya with ketamine and other drugs. She is lucky to be alive.
This might also be part of why Beata committed suicide. I hope the hospital drags the K family through appellate hell if they win anything from this jury. If the jury heard that testimony that was proferred, I think that would turn the case on it's head.]
I agree. Getting more info about the case that wasn't in the documentary, dependency court would see and hear ALL of this medical testimony and Beata would certainly have lost parental access and control. Not parental rights as that can take years but she would have had to undergo all kinds of evaluations, participate in treatment and corrective behaviors etc. Shelter care is just the initial several months to gather information, then the court will direct additional interventions and whether and when the child is safe to return home. Shit it took 3 years to terminate a mother's parental rights after she threw her newborn baby over a fence in freezing temps next to a drainage pond on one of my cases. The court gave that woman every opportunity to get her child back and she finally agreed to let the child be in open adoption with a relative.
I think Jack would certainly divorce her to keep Maya in family care and she was going to be exposed. But what pisses me off is Jack. He failed to protect this child and as a GAL I have recommended parents undergo parenting classes and psychiatric evaluations to ensure the parent is capable of protecting the child from others. He was retired but seems like he was just along for the ride.
This might also be part of why Beata committed suicide. I hope the hospital drags the K family through appellate hell if they win anything from this jury. If the jury heard that testimony that was proferred, I think that would turn the case on it's head.]
I agree. Getting more info about the case that wasn't in the documentary, dependency court would see and hear ALL of this medical testimony and Beata would certainly have lost parental access and control. Not parental rights as that can take years but she would have had to undergo all kinds of evaluations, participate in treatment and corrective behaviors etc. Shelter care is just the initial several months to gather information, then the court will direct additional interventions and whether and when the child is safe to return home. Shit it took 3 years to terminate a mother's parental rights after she threw her newborn baby over a fence in freezing temps next to a drainage pond on one of my cases. The court gave that woman every opportunity to get her child back and she finally agreed to let the child be in open adoption with a relative.
I think Jack would certainly divorce her to keep Maya in family care and she was going to be exposed. But what pisses me off is Jack. He failed to protect this child and as a GAL I have recommended parents undergo parenting classes and psychiatric evaluations to ensure the parent is capable of protecting the child from others. He was retired but seems like he was just along for the ride.
Taking Care of Maya - FL CPS/Munchausen case
your experiences are very similar to mine. And in my one MBP case, mom lost access to the child but was never terminated. (Parents were divorced).Taking Care of Maya - FL CPS/Munchausen case
Defense witness – Dr Jennifer McCain, Pediatric Neuropsychologist, Tampa General Hospital
Ph.D, Clinical Psych, Bd certified in Neuropsych and Pediatric NeuroPsych
Chief of Psychology, Chief of NeuroPsych
Her work is focused on traumatic brain injury, rehabilitation
Maya spent 4 weeks approx. at TGH
Part of the interdisciplinary team, ARNP, PT, OT, Speech Language, Child Life, Psych, School
Exhibit – 7/31/2015 1st consult note – (In September of 2015, Beata claims Maya to have sprained her ankle doing gymnastics in early July 2015. But she was already in a wheelchair per physician records and between July and Sept of 2015 never mentioned it until her mother did research and then it was her mother that initially told Dr Kirkpatrick “burning” pain, sprained ankle, arms and legs. So, this is before the research and before any “burning” pain was ever mentioned)
Referred by Dr Kornberg, who was overseeing her PT Rehab
History of present illness, through medical records – talks about an admission to ACH where she was seen by a neurologist there.
Exhiibit – Family historian “Dad” –
(the mention of “scary” illness I believe is related to Beata telling her she has immune deficiency. Up to this point there was no research on CRPS, nothing but asthma and high steroid use. It was discussed that she had a single marker of immune that was deficient, related to her use of steroid. This seemed to be the time mom started seeking an immune deficiency diagnosis. I am putting this together from the time stamps of when she saw which doctors and for what complaint.)
Current status – Witness is reading the above exhibit. Her mood was neutral, no evidence of depression. She does not independently recall anything so she has to go by her notes. There is no mention of pain in this note. At the bottom she mentioned recommending Hospital Homebound school.
Treatment Poan –
She explains cognitive restructuring as understanding how thoughts affect how we feel and how the thoughts may not be rational and contribute to what we experience. It was one of the plans
It is important for family to understand and cooperate with treatment in order for the treatment to work
Exhibit – 5 days later
The goal of meeting with PT at the same time is used when a child has behavioral issues during therapy. We try to work together to figure out the best way to help the child participate in therapy to make it more effective.
What was the significance of the part of the note that discusses brother and mom. Dr responds it illustrates how drastically Maya’s behavior changed when topic was switched to an issue related to family. The quote came directly from Maya. She was unable to identify where her pain was, only that it was not in her stomach and that head pain was very high.
Dysphoric means sad, labile means emotions come on very quickly, cries at the drop of a hat.
Giving positive reinforcement for behavior that is not exaggerated and ignoring exaggerated behavior. Behavior dysregulation is a general term for an inability to regulate behavior.
Exhibit 3rd visit. -
Had a chance to meet with Mrs K. She noted highly indicative of conversion disorder. She has symptoms that cannot be found to have a basis in a neurological disorder. Mrs K verbalized similar observations and she indicated an acceptance of the diagnosis
Exhibit – 4th visit – Aud 11 – 5 days later
Mr K appeared at some point during the therapy. Met with Maya while in wheelchair, she expressed no sign of pain, she was engaged in an activity of scrapbooking and was using her hands very well without any sign of pain, when she previously had said she was unable to do anything with her hands and they were weak.
Maya raising concerns about not going to school in person. Dr told Maya she should be able to return to school because she seemed to be making enough progress.
Maya was open about discussin family dynamics. This is normal to have this discussion. Often family dynamics are contributing to current presentation. Maya expressed that she wanted to spend more time with Mom and that Mom was working a lot. She encouraged Maya to express this to her father.
She did speak with Mr K about this. Mr K indicated that Mom worked al lot and that he was the primary caregiver. He agreed with outpatient treatment.
Next visit notes –
Maya appeared in this session to be trying to get the attention of her mother. This is significant because it appears to be contributing heavily to her disability.
Mrs K decided that she did not agree with the diagnosis after she had gone home and thought about it.
When the whole group was together, therapist, Mom, Maya, Dr McCain, Maya was crying, whimpering, acting out and the adults were ignoring that behavior which is part of not encouraging the acting out. As soon as Dr McCain stood up to leave, Maya instantly stopped that behavior.
6th visit
Is this typical to meet with family often throughout the PT sessions? It depends son the diagnosis or needs. Hers psych needs were more intensive at this time.
Had a meeting with Mom and they were observing Maya in PT. FND is another term for conversion disorder. Mom showed resistance but somewhat open to FND/CD but only after a neurologist visit.
Who is Dr Ghiron – a pediatric neurologist. Was this the consult with the neurologist something you would review in the course of your practice? Yes
Dr McCain would look at the entire consult note, it is all relevant to her
This helped to inform my future care of Maya. Dr Geiron could not find a neurologic basis for any of Maya’s symptoms.
No pain expressed during session. She was getting discharged and we talked about her returning to school. She believed Maya could return to school. She didn’t care if she missed school and did not seem motivated to go back to school or work on schoolwork at hospital.
Was done on day of discharge. Psych factor affecting Physical Condition is diagnosis #4
Barriers to discharge plan – work schedule may interfere with ability to carry out the discharge plan
Made recommendations to follow up with mental health after discharge. She is confident of her FND/CD diagnosis and that Maya needed psych care
Maya was anxious about going home. Tried to focus Maya on goals of continuing therapy and return to school. She believed Maya should be able to return to school
Discharge Summary prepared by Dr Kornberg and Dr McCain’s portion was pulled out of patient meeting notes from interdisciplinary team meeting
After discharge she followed up with Mrs K
Maya did not qualify for Hospital Homebound because she did not have an actual medical diagnosis. Her diagnosis was related to psychological factors that needed attention and that doesn’t qualify for homebound schooling. (This is very interesting)
I’m not going to write up the cross exam, it was ridiculous and he got nothing from her. At one point the judge interrupted and brought the attorneys up to the bench and then Mr Anderson indicated he had no more. I think the judge is fed up with Anderson wasting all the additional time he keeps giving him. He badgers witnesses relentlessly on points they are simply not going to give him. This witness was no different
Jury questions
1. In your testimony you used the phrase similar to psychological contribution. Should I interpret this to mean there is a mental component but also a physical component? The patient is having symptoms without an underlying physical cause. It is psychological factors that are fueling the symptoms
2. You said you don’t know what a normal child is. With all your credentials can you possibly agree there are norms in evaluating a child behavior? Yes
3. We don’t have a normal baseline to use and if you don’t know what a normal child is, how can you determine? In terms of behavior you have norms, just as in IQ you have norms. When I used this term I was talking about from the child’s point of view
Defense follow up
Maya was highly inconsistent with her symptoms. She exaggerated a lot and her parents both even acknowledged this habit she had
Plaintiff
Showing the clip of “giddyup horsey” PT session. This is where Maya is obviously being dramatic and exaggerating her “attempt” at walking. Most of the witnesses have been just agreeing that she is “trying hard” to walk. This witness says that she “could be trying” to walk.
Based on all my experience with her, yes, I believe she has conversion disorder.
More jury questions
The questions cannot be asked. The plaintiff seems angry about it. It. He will allow the attorneys to ask additional questions
Plaintiff:
1. Did you have the opportunity to review the therapist notes for the clip that you just viewed? No, I did not
2. So you can’t tell one way or another if wht that note said was consistent with what your vew was? Correct
Defense:
1. You actually took it upon yourself to observe Maya personally while she was in PT, correct? Yes
Juror question
Cannot be asked
Witness excused
Ph.D, Clinical Psych, Bd certified in Neuropsych and Pediatric NeuroPsych
Chief of Psychology, Chief of NeuroPsych
Her work is focused on traumatic brain injury, rehabilitation
Maya spent 4 weeks approx. at TGH
Part of the interdisciplinary team, ARNP, PT, OT, Speech Language, Child Life, Psych, School
Exhibit – 7/31/2015 1st consult note – (In September of 2015, Beata claims Maya to have sprained her ankle doing gymnastics in early July 2015. But she was already in a wheelchair per physician records and between July and Sept of 2015 never mentioned it until her mother did research and then it was her mother that initially told Dr Kirkpatrick “burning” pain, sprained ankle, arms and legs. So, this is before the research and before any “burning” pain was ever mentioned)
Referred by Dr Kornberg, who was overseeing her PT Rehab
History of present illness, through medical records – talks about an admission to ACH where she was seen by a neurologist there.
Exhiibit – Family historian “Dad” –
(the mention of “scary” illness I believe is related to Beata telling her she has immune deficiency. Up to this point there was no research on CRPS, nothing but asthma and high steroid use. It was discussed that she had a single marker of immune that was deficient, related to her use of steroid. This seemed to be the time mom started seeking an immune deficiency diagnosis. I am putting this together from the time stamps of when she saw which doctors and for what complaint.)
Current status – Witness is reading the above exhibit. Her mood was neutral, no evidence of depression. She does not independently recall anything so she has to go by her notes. There is no mention of pain in this note. At the bottom she mentioned recommending Hospital Homebound school.
Treatment Poan –
She explains cognitive restructuring as understanding how thoughts affect how we feel and how the thoughts may not be rational and contribute to what we experience. It was one of the plans
It is important for family to understand and cooperate with treatment in order for the treatment to work
Exhibit – 5 days later
The goal of meeting with PT at the same time is used when a child has behavioral issues during therapy. We try to work together to figure out the best way to help the child participate in therapy to make it more effective.
What was the significance of the part of the note that discusses brother and mom. Dr responds it illustrates how drastically Maya’s behavior changed when topic was switched to an issue related to family. The quote came directly from Maya. She was unable to identify where her pain was, only that it was not in her stomach and that head pain was very high.
Dysphoric means sad, labile means emotions come on very quickly, cries at the drop of a hat.
Giving positive reinforcement for behavior that is not exaggerated and ignoring exaggerated behavior. Behavior dysregulation is a general term for an inability to regulate behavior.
Exhibit 3rd visit. -
Had a chance to meet with Mrs K. She noted highly indicative of conversion disorder. She has symptoms that cannot be found to have a basis in a neurological disorder. Mrs K verbalized similar observations and she indicated an acceptance of the diagnosis
Exhibit – 4th visit – Aud 11 – 5 days later
Mr K appeared at some point during the therapy. Met with Maya while in wheelchair, she expressed no sign of pain, she was engaged in an activity of scrapbooking and was using her hands very well without any sign of pain, when she previously had said she was unable to do anything with her hands and they were weak.
Maya raising concerns about not going to school in person. Dr told Maya she should be able to return to school because she seemed to be making enough progress.
Maya was open about discussin family dynamics. This is normal to have this discussion. Often family dynamics are contributing to current presentation. Maya expressed that she wanted to spend more time with Mom and that Mom was working a lot. She encouraged Maya to express this to her father.
She did speak with Mr K about this. Mr K indicated that Mom worked al lot and that he was the primary caregiver. He agreed with outpatient treatment.
Next visit notes –
Maya appeared in this session to be trying to get the attention of her mother. This is significant because it appears to be contributing heavily to her disability.
Mrs K decided that she did not agree with the diagnosis after she had gone home and thought about it.
When the whole group was together, therapist, Mom, Maya, Dr McCain, Maya was crying, whimpering, acting out and the adults were ignoring that behavior which is part of not encouraging the acting out. As soon as Dr McCain stood up to leave, Maya instantly stopped that behavior.
6th visit
Is this typical to meet with family often throughout the PT sessions? It depends son the diagnosis or needs. Hers psych needs were more intensive at this time.
Had a meeting with Mom and they were observing Maya in PT. FND is another term for conversion disorder. Mom showed resistance but somewhat open to FND/CD but only after a neurologist visit.
Who is Dr Ghiron – a pediatric neurologist. Was this the consult with the neurologist something you would review in the course of your practice? Yes
Dr McCain would look at the entire consult note, it is all relevant to her
This helped to inform my future care of Maya. Dr Geiron could not find a neurologic basis for any of Maya’s symptoms.
No pain expressed during session. She was getting discharged and we talked about her returning to school. She believed Maya could return to school. She didn’t care if she missed school and did not seem motivated to go back to school or work on schoolwork at hospital.
Was done on day of discharge. Psych factor affecting Physical Condition is diagnosis #4
Barriers to discharge plan – work schedule may interfere with ability to carry out the discharge plan
Made recommendations to follow up with mental health after discharge. She is confident of her FND/CD diagnosis and that Maya needed psych care
Maya was anxious about going home. Tried to focus Maya on goals of continuing therapy and return to school. She believed Maya should be able to return to school
Discharge Summary prepared by Dr Kornberg and Dr McCain’s portion was pulled out of patient meeting notes from interdisciplinary team meeting
After discharge she followed up with Mrs K
Maya did not qualify for Hospital Homebound because she did not have an actual medical diagnosis. Her diagnosis was related to psychological factors that needed attention and that doesn’t qualify for homebound schooling. (This is very interesting)
I’m not going to write up the cross exam, it was ridiculous and he got nothing from her. At one point the judge interrupted and brought the attorneys up to the bench and then Mr Anderson indicated he had no more. I think the judge is fed up with Anderson wasting all the additional time he keeps giving him. He badgers witnesses relentlessly on points they are simply not going to give him. This witness was no different
Jury questions
1. In your testimony you used the phrase similar to psychological contribution. Should I interpret this to mean there is a mental component but also a physical component? The patient is having symptoms without an underlying physical cause. It is psychological factors that are fueling the symptoms
2. You said you don’t know what a normal child is. With all your credentials can you possibly agree there are norms in evaluating a child behavior? Yes
3. We don’t have a normal baseline to use and if you don’t know what a normal child is, how can you determine? In terms of behavior you have norms, just as in IQ you have norms. When I used this term I was talking about from the child’s point of view
Defense follow up
Maya was highly inconsistent with her symptoms. She exaggerated a lot and her parents both even acknowledged this habit she had
Plaintiff
Showing the clip of “giddyup horsey” PT session. This is where Maya is obviously being dramatic and exaggerating her “attempt” at walking. Most of the witnesses have been just agreeing that she is “trying hard” to walk. This witness says that she “could be trying” to walk.
Based on all my experience with her, yes, I believe she has conversion disorder.
More jury questions
The questions cannot be asked. The plaintiff seems angry about it. It. He will allow the attorneys to ask additional questions
Plaintiff:
1. Did you have the opportunity to review the therapist notes for the clip that you just viewed? No, I did not
2. So you can’t tell one way or another if wht that note said was consistent with what your vew was? Correct
Defense:
1. You actually took it upon yourself to observe Maya personally while she was in PT, correct? Yes
Juror question
Cannot be asked
Witness excused
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Maclilly, I totally agree with being angry at Jack. I saw him a little different at first, but as things are progressing I am really angry that he allowed all of this treatment to happen in the first place. I am floored that while he was the retired stay at home caregiver, it was Beata that was dragging Maya all over the one doctor/hospital after another seeking diagnosis for illnesses that typically require substantial interventions.
Visiting three different immunologists seeking a diagnosis of immune deficiency was eye opening. The kind of treatment Maya could have potentially received if Beata had succeeded in finding an immunologist quack is scary as hell. Thank goodness the three that she saw apparently were all competent and did not give her this diagnosis, but damn, she sought out three that we know of. Who knows how many more she may have visited from out of town that she never admitted to.
Unfortunately, this testimony went straight over the jury's head, as evidenced by their questioning. this is the one super effective cross examination by Mr Anderson, who is typically an incompetent boob. He succeeded in turning that whole testimony into discussion about CRPS instead of on the fact that Dr Mendez had uncovered evidence of diagnosis-seeking behavior aside from seeking the CRPS diagnosis. As well as apparently Beata successfully convinced someone to prescribe heavy steroids based only on Beata claiming Maya had severe asthma.
Visiting three different immunologists seeking a diagnosis of immune deficiency was eye opening. The kind of treatment Maya could have potentially received if Beata had succeeded in finding an immunologist quack is scary as hell. Thank goodness the three that she saw apparently were all competent and did not give her this diagnosis, but damn, she sought out three that we know of. Who knows how many more she may have visited from out of town that she never admitted to.
Unfortunately, this testimony went straight over the jury's head, as evidenced by their questioning. this is the one super effective cross examination by Mr Anderson, who is typically an incompetent boob. He succeeded in turning that whole testimony into discussion about CRPS instead of on the fact that Dr Mendez had uncovered evidence of diagnosis-seeking behavior aside from seeking the CRPS diagnosis. As well as apparently Beata successfully convinced someone to prescribe heavy steroids based only on Beata claiming Maya had severe asthma.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Interestingly, I had a foster mom who I suspected had some MH issues claiming the kids she adopted and fostered were special needs. I first thought it was for money, but later realized it was about her need to control everything. When I came on to a little boy's case, he was her THIRD child who had the same "special needs", hypersensitivity, required all kinds of therapies, weighted vests, etc. The two younger girls, already adopted, about 7 & 9 had the same condition yet none of the children were related. She complained that I had arranged for dad to have a visit at a local park because the noise and activity would be too overstimulating for the child, yet she rescheduled a later visit for dad so she could take the child to a Mariner's game at the stadium. So that's not too loud and over stimulating???
She also claimed the child could not take a bath because it was too painful to him, yet at dad's, as soon as he announced bath time kiddo ran to the tub and stripped naked laughing and throwing his toys in the tub. I finally had it when I got the dad an overnight moving towards transition and foster mom immediately ran to a child psych the next day and claimed the child was traumatized by the overnight. I called the psychologist after reading her report and dug deeper into her recommendation and got her to confess it was all based on foster mom's report and she had not witnessed any "disturbing" traumatic behavior herself. She totally backed down and changed her recommendation.
I'd also made written complaints to CPS that FM was a hoarder and her home was filthy and not appropriate to have a young child crawling on the filthy ground, items stacked to the ceiling that could fall on top of him. FM tried to get the state to pay for housekeeping to come help her cause it was so overwhelming to have 3 special needs kids (who she homeschooled) and didn't have time to clean. I was so mad at the SW cause she would not listen and even an occ therapist filed a complaint about the home's condition and FM's interference in home treatment. It was so bad I even finally got the state Ombudsmen involved and finally foster licensing pulled her license. She and husband separated after that.
I got the little boy home with dad who was a totally innocent bystander of the situation (mom was addicted to meth and they weren't even together) but CPS was out to deny this man because he was Hispanic, didn't speak a lick of English and was undocumented.
Taking Care of Maya - FL CPS/Munchausen case
Get ready for NoPainHanna.comThis is one of the quacks that treated Maya. I can see why the Plaintiff didn't bring him in person and now the defense is showing his deposition. Quackaroo. Runs a ketamine clinic and advertises online. Here's one line from his testimony - Beata found him after doing research online. So she wasn't referred by her primary care doctor, which I think I already suspected. And, she had to do a GoGriftMe for all these treatments because they aren't covered under insurance.
I'm not saying he's a quack because he runs a ketamine clinic, I know that does help people with legitimate pain conditions. I'm calling him a quack for just taking Beata's description of CRPS that she read online and diagnosing Maya without any real exam or question as to whether she had it.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Defense -= Dr Ashraf Hanna –
No hospital privileges. Why would I have that? I don’t have patients there
No referral, blank referral, mom did online research. Sometimes if insurance needed they get a referral from primary care. This family did online research.
IV ketamine for 12 years
IVKetamine.com and NoPainHanna.com
Did you talk to a psychologist in 2015 to get an idea of hoe Maya was doing from a psych standpoint? No, I did not
Infusing Maya what type of monitoring? EKG and (?) monitoring. Standard of care.
Treatment of ketamine has been successful for her. They showed me picture of her jumped in the pool, doing activities, saw friends and family, had very successful results .
At what point would you determine with a patient like Maya that we’ve had this uptake response we need to stop it and dial it back? If her condition mproves or her vitals become unstable, or any changes in liver enzymes then we stop
Abdominal pain – that is from the liver. So then I sent her to JHACH. Why? Because I failed to help her. There was nothing else I could do to help her. I told the mother, that is the maximum I can do. I can’t give her any more. She has abdominal pain, I can’t increase her ketamine, she needs help from a bigger place. Maybe they can do some continuous infusion, and see why she’s having abdominal pain. They can do some lab work, maybe make sure nothing else is going on. (Maybe the REAL reason the plaintiff did not put this witness on. Dr Kirkpatrick only gave her two infusions. Dr Cantu in Mexico gave her two infusions. This guy gave her 55 infusions in less than one year.)
If I couldn’t control her with my ability and my maximum infusions that I could do, then it’s time for me to send her to another facility.
Is it fair to say that Oct 6, 2016, the last infusion you ever gave her was the maximum that you felt comfortable with? Yes
Did you write the order to have a port placed? Yes
Oct 6, 2016 the patient is at 10 out of 10 pain with pain medication and the previous infusions, so you went up to 1250 mg plus a 50 mg ketamine bolus and you did the infusion over a shorter period of time, 2 hours. Which get us to above 24 mg/kg/hr
What was the medical decision making to go up to this amount on Oct 6? As you see, she came in with a pain of 10 out of 10, she was crying, screaming. She was crying from pain. Her mother stated that “I cannot live, she’s screaming and crying all night”. This is the patient I’m having in front of me, I did everything I could the say before. I discussed with the mother, she said OK, actually the father was there, you know, and I discussed the case with him, I said I’m really running out of options. I don’t want to give her more dosing, but let’s see if I give it to her in a shorter period of time, that we can achieve a better result.
(OMG)
(LOL, the defense attorney is letting him drone on and on, this is good for the defense. He’s making their case for them pretty much by himself)
And I told him this is the maximum I can do. Otherwise we just have to send her to the hospital.
Is it possible that the abdominal pain could be caused by these infusions? I mean it can be, it is a side effect. Just like we needed to send her to the hospital to get lab testing and help
Do you remember writing several prescriptions for oral ketamine to be given at home, do you remember that? Yes
Beata K signed an agreement at the end of treatment, I had kept her in somehow better improved of quality of life for a while. During the year she had better pain relief, her pain went up about 3 or 4 or 8 or 9. At the end of 9 months, she filled out a questionnaire and rated her quality of life as ZERO, are you telling the jury that she had a better quality of life? You have to look at it as there was a lot of time she was better. She had a flare. She had a downside. Any time with CRPS this happens (I want to scream) We tell you she has ups and downs (no, with conversion disorder an dpsych problems you have ups and downs. CRPS symptoms are either all the same all tie time or you are lucky to be a child who goes into remission, which is not ups and downs)
For whatever reason, she had a flareup that’s why I sent her to the hospital. OMG, he is yelling at the attorney – You have not seen CRPS patients, you have not treated CRPS patients. (I don’t think he has either. He has a website called NoPainHanna.com – he treats general pain of any kind. I don’t think he’s any kind of a CRPS expert)
He’s done thousands of CRPS patients from all over the world. (yeah, right. Dr Crane, who is a real CRPS expert said he flat out does not believe this, said it’s nonsense. There aren’t that many people who have it that are going to some to Florida for NoPainHanna.com)
So she comes to you with a quality of life scale in January of 2 and she leaves with a quality of life scale of Zero and you are sending her to ACH emergency room and that’s considered successful treatment of CRPS? Sure. She had a flare. The treatment didn’t end. They ended it (Um. Except earlier he said he was at the end of what he could do,)
(He sounds like a crazy man at this point, yelling and screaming that she had videos and pictures showing improvement at times. My god, keep this man talking and the jury just might forget all about how they are on the side of this sweet innocent little girl that got treated so badly at the hospital)
They are letting him rant on and on.
Now, he says didn’t you say earlier that you reached the maximum amount you could give her? He says “At that time, sir” (OMG, I saw his body language, he meant he reached his limit period. Now, he’s defending himself and arguing because of the quality of life = zero question and his ego is bruised so he’s changing his mind)
I will embed the video, it’s a hoot.
I don’t know why she was having that side effect, I wanted to make sure there was no other underlying condition that is causing this pain.
She hadn’t eaten in five days. Is that normal with high dose ketamine? I was not aware of it. Yes, I would probably not have treated her, taken a break for her to eat if I knew that.
Did you ask her how she was eating? I did not
I attempted to enter ACH to see Maya, turned away to see her as a doctor because had no privileges. He could visit as a friend. He applied for something I don’t remember. The judge said I could go see her, they sent me some paperwork, then went I went
How much relief did you document from Jan 2017 to Jun 2017? I documented 60-70% relief. Was she on ketamine? No, Do you know what she was doing that led to that relief? No, I mean I believe she was doing therapy. It says here she was doing PT/Pool therapy/ OT
Within a reasonable degree of medical probability do you think the 60 – 70% relief that you documented was due to the ketamine that you delivered to her from Jan 2016 – Oct 2016? It can be, there is a very good probability that it can be (OMG) More likely than not? Yes. Because she tried the ketamine and it did not help her, she had tried the therapy before and it did not help her, so it was the ketamine
(WHUT????????. This guy is actually a doctor. MD)
The therapy made her pain worse. With regard to the handoff from ketamine from Dr Cantu to you did you get Dr Kirkpatrick’s records? Yes. Her primary care? NO. Ever speak with him? No
2nd Deposition
We were sent some records pursuant to a subpoena for standing orders for ketamine from your office? (Objection)
(We are going to get into those records that were in Maya’s file and they were for ketamine infusion to be used at home)
Are those your standard and maintenance doses for CRPS patients receiving ketamine? Yes, but again, dosage left up to MD discretion
But your standard dose is 1 mg/kg/hr? Yes, general guidelines, I titrate.
How often more than 20 mg/kg/hr in yor practice. Not that common
How did you come to gather from Dr Cantu that happened in Mexico? From a phone call
Where in your chart is there a statement from a psychiatrist clearing Maya K for ketamine treatment and ruling out underlying issues with schizophrenia? Wel I know that Maya was seeing a psych. This is usually for fresh patients , who never got ketamine before. Maya saw Dr K and Dr Cantu, also he does require psych clearance, so she already had IV ketamine before
So relying in Dr K for psych clearance? Yes
There is no record that Maya ever saw a psych for clearance for Dr K, are you aware of that? I know she was seeing a psych and she knew she was getting infusions. I know she was cleared, at least Dr K felt comfortable and I felt comfortable.
This is all new to me now. Do you recall referring Maya K for implantation of a port for ketamine infusions? I do recall needing that
Did you discuss this with the surgeon to place the port? No, but I recall we had difficulty with IVs so I needed the port we don’t want to torture a young girl with IVs
Caudid block? Epidural injection. Lidocaine or something like that. Just something to block the pain signals coming from the legs to the spinal chord.
Longest infusion for Maya four hours
No scheduled visit for this, maybe just a conversation. Can you look in your records and see if there was a scheduled visit for Monday, Oct 10, 2016 or Oct 11, 2016. He has Oct 10, they can be fro before, but I don’t know when it was scheduled. We usually scheduled monthly.
10/10/2016 No show
10/11/2016 No show
She didn’t know too much about it. Do you recall how Dr Sally Smith introduced herself to you? No
Apply for privileges at ACH? I don’t know
They approved me seeing her and when I went they declined me from seeing her (he was probably approved as a friend, not doctor to treat) He doesn’t even know why he was declined to see her
How often do yu have infusions for 4 hours, then 3 hours, then 2? Sometimes, I don’t know,
Reviewed Dr Kirkpatrick prior to infusing Maya
He talked personally to Dr Cantu, probably at least 30 mins.
Do you save emails in the chart if you email a patient? Yes, they should be there
None are there, do you know why? I don’t know
Some emails made way into the chart, and some did not. He doesn’t know why
What are we looking at. A prescription that says it’s medically necessary for a port for infusions.
It’s a request, not an order. I don’t know who ordered it. Maybe primary care or the surgeon. We usually put a request in
You were the attending physician in 2016 for Maya? That is correct (LOL, attending physician. He was her pain quack)
You were responsible for her pain management. Yes
Review of literature at the time support your treatment? Yes (no, not really)
She was not under any danger
Liver studies were done
Any change in liver function indicative to side effect. No (except he said that was what he was concerned about when he sent her to the hospital with abdominal pain)
Did you meet and get to know Beata K? Yes
How many doctors did you speak to about Maya? Two
Had ketamine worked in the past? Yes
Titrating – adjust the dose based on affect and side effects
Monitoring? Yes
Medically necessary? Yes
CRPS pain – describe to jury. Worst possible pain, number one cause of suicide from pain condition
I am board certified pain management/anesthesiologist, 25 years
Beata K was a concerned, attentive mother
How is she doing today? A-plus student
Last time ketamine? Oct 2016
Weight during the entire year of 2016? 27 kg (no weight gain at all, 9 year old child)
No hospital privileges. Why would I have that? I don’t have patients there
No referral, blank referral, mom did online research. Sometimes if insurance needed they get a referral from primary care. This family did online research.
IV ketamine for 12 years
IVKetamine.com and NoPainHanna.com
Did you talk to a psychologist in 2015 to get an idea of hoe Maya was doing from a psych standpoint? No, I did not
Infusing Maya what type of monitoring? EKG and (?) monitoring. Standard of care.
Treatment of ketamine has been successful for her. They showed me picture of her jumped in the pool, doing activities, saw friends and family, had very successful results .
At what point would you determine with a patient like Maya that we’ve had this uptake response we need to stop it and dial it back? If her condition mproves or her vitals become unstable, or any changes in liver enzymes then we stop
Abdominal pain – that is from the liver. So then I sent her to JHACH. Why? Because I failed to help her. There was nothing else I could do to help her. I told the mother, that is the maximum I can do. I can’t give her any more. She has abdominal pain, I can’t increase her ketamine, she needs help from a bigger place. Maybe they can do some continuous infusion, and see why she’s having abdominal pain. They can do some lab work, maybe make sure nothing else is going on. (Maybe the REAL reason the plaintiff did not put this witness on. Dr Kirkpatrick only gave her two infusions. Dr Cantu in Mexico gave her two infusions. This guy gave her 55 infusions in less than one year.)
If I couldn’t control her with my ability and my maximum infusions that I could do, then it’s time for me to send her to another facility.
Is it fair to say that Oct 6, 2016, the last infusion you ever gave her was the maximum that you felt comfortable with? Yes
Did you write the order to have a port placed? Yes
Oct 6, 2016 the patient is at 10 out of 10 pain with pain medication and the previous infusions, so you went up to 1250 mg plus a 50 mg ketamine bolus and you did the infusion over a shorter period of time, 2 hours. Which get us to above 24 mg/kg/hr
What was the medical decision making to go up to this amount on Oct 6? As you see, she came in with a pain of 10 out of 10, she was crying, screaming. She was crying from pain. Her mother stated that “I cannot live, she’s screaming and crying all night”. This is the patient I’m having in front of me, I did everything I could the say before. I discussed with the mother, she said OK, actually the father was there, you know, and I discussed the case with him, I said I’m really running out of options. I don’t want to give her more dosing, but let’s see if I give it to her in a shorter period of time, that we can achieve a better result.
(OMG)
(LOL, the defense attorney is letting him drone on and on, this is good for the defense. He’s making their case for them pretty much by himself)
And I told him this is the maximum I can do. Otherwise we just have to send her to the hospital.
Is it possible that the abdominal pain could be caused by these infusions? I mean it can be, it is a side effect. Just like we needed to send her to the hospital to get lab testing and help
Do you remember writing several prescriptions for oral ketamine to be given at home, do you remember that? Yes
Beata K signed an agreement at the end of treatment, I had kept her in somehow better improved of quality of life for a while. During the year she had better pain relief, her pain went up about 3 or 4 or 8 or 9. At the end of 9 months, she filled out a questionnaire and rated her quality of life as ZERO, are you telling the jury that she had a better quality of life? You have to look at it as there was a lot of time she was better. She had a flare. She had a downside. Any time with CRPS this happens (I want to scream) We tell you she has ups and downs (no, with conversion disorder an dpsych problems you have ups and downs. CRPS symptoms are either all the same all tie time or you are lucky to be a child who goes into remission, which is not ups and downs)
For whatever reason, she had a flareup that’s why I sent her to the hospital. OMG, he is yelling at the attorney – You have not seen CRPS patients, you have not treated CRPS patients. (I don’t think he has either. He has a website called NoPainHanna.com – he treats general pain of any kind. I don’t think he’s any kind of a CRPS expert)
He’s done thousands of CRPS patients from all over the world. (yeah, right. Dr Crane, who is a real CRPS expert said he flat out does not believe this, said it’s nonsense. There aren’t that many people who have it that are going to some to Florida for NoPainHanna.com)
So she comes to you with a quality of life scale in January of 2 and she leaves with a quality of life scale of Zero and you are sending her to ACH emergency room and that’s considered successful treatment of CRPS? Sure. She had a flare. The treatment didn’t end. They ended it (Um. Except earlier he said he was at the end of what he could do,)
(He sounds like a crazy man at this point, yelling and screaming that she had videos and pictures showing improvement at times. My god, keep this man talking and the jury just might forget all about how they are on the side of this sweet innocent little girl that got treated so badly at the hospital)
They are letting him rant on and on.
Now, he says didn’t you say earlier that you reached the maximum amount you could give her? He says “At that time, sir” (OMG, I saw his body language, he meant he reached his limit period. Now, he’s defending himself and arguing because of the quality of life = zero question and his ego is bruised so he’s changing his mind)
I will embed the video, it’s a hoot.
I don’t know why she was having that side effect, I wanted to make sure there was no other underlying condition that is causing this pain.
She hadn’t eaten in five days. Is that normal with high dose ketamine? I was not aware of it. Yes, I would probably not have treated her, taken a break for her to eat if I knew that.
Did you ask her how she was eating? I did not
I attempted to enter ACH to see Maya, turned away to see her as a doctor because had no privileges. He could visit as a friend. He applied for something I don’t remember. The judge said I could go see her, they sent me some paperwork, then went I went
How much relief did you document from Jan 2017 to Jun 2017? I documented 60-70% relief. Was she on ketamine? No, Do you know what she was doing that led to that relief? No, I mean I believe she was doing therapy. It says here she was doing PT/Pool therapy/ OT
Within a reasonable degree of medical probability do you think the 60 – 70% relief that you documented was due to the ketamine that you delivered to her from Jan 2016 – Oct 2016? It can be, there is a very good probability that it can be (OMG) More likely than not? Yes. Because she tried the ketamine and it did not help her, she had tried the therapy before and it did not help her, so it was the ketamine
(WHUT????????. This guy is actually a doctor. MD)
The therapy made her pain worse. With regard to the handoff from ketamine from Dr Cantu to you did you get Dr Kirkpatrick’s records? Yes. Her primary care? NO. Ever speak with him? No
2nd Deposition
We were sent some records pursuant to a subpoena for standing orders for ketamine from your office? (Objection)
(We are going to get into those records that were in Maya’s file and they were for ketamine infusion to be used at home)
Are those your standard and maintenance doses for CRPS patients receiving ketamine? Yes, but again, dosage left up to MD discretion
But your standard dose is 1 mg/kg/hr? Yes, general guidelines, I titrate.
How often more than 20 mg/kg/hr in yor practice. Not that common
How did you come to gather from Dr Cantu that happened in Mexico? From a phone call
Where in your chart is there a statement from a psychiatrist clearing Maya K for ketamine treatment and ruling out underlying issues with schizophrenia? Wel I know that Maya was seeing a psych. This is usually for fresh patients , who never got ketamine before. Maya saw Dr K and Dr Cantu, also he does require psych clearance, so she already had IV ketamine before
So relying in Dr K for psych clearance? Yes
There is no record that Maya ever saw a psych for clearance for Dr K, are you aware of that? I know she was seeing a psych and she knew she was getting infusions. I know she was cleared, at least Dr K felt comfortable and I felt comfortable.
This is all new to me now. Do you recall referring Maya K for implantation of a port for ketamine infusions? I do recall needing that
Did you discuss this with the surgeon to place the port? No, but I recall we had difficulty with IVs so I needed the port we don’t want to torture a young girl with IVs
Caudid block? Epidural injection. Lidocaine or something like that. Just something to block the pain signals coming from the legs to the spinal chord.
Longest infusion for Maya four hours
No scheduled visit for this, maybe just a conversation. Can you look in your records and see if there was a scheduled visit for Monday, Oct 10, 2016 or Oct 11, 2016. He has Oct 10, they can be fro before, but I don’t know when it was scheduled. We usually scheduled monthly.
10/10/2016 No show
10/11/2016 No show
She didn’t know too much about it. Do you recall how Dr Sally Smith introduced herself to you? No
Apply for privileges at ACH? I don’t know
They approved me seeing her and when I went they declined me from seeing her (he was probably approved as a friend, not doctor to treat) He doesn’t even know why he was declined to see her
How often do yu have infusions for 4 hours, then 3 hours, then 2? Sometimes, I don’t know,
Reviewed Dr Kirkpatrick prior to infusing Maya
He talked personally to Dr Cantu, probably at least 30 mins.
Do you save emails in the chart if you email a patient? Yes, they should be there
None are there, do you know why? I don’t know
Some emails made way into the chart, and some did not. He doesn’t know why
What are we looking at. A prescription that says it’s medically necessary for a port for infusions.
It’s a request, not an order. I don’t know who ordered it. Maybe primary care or the surgeon. We usually put a request in
You were the attending physician in 2016 for Maya? That is correct (LOL, attending physician. He was her pain quack)
You were responsible for her pain management. Yes
Review of literature at the time support your treatment? Yes (no, not really)
She was not under any danger
Liver studies were done
Any change in liver function indicative to side effect. No (except he said that was what he was concerned about when he sent her to the hospital with abdominal pain)
Did you meet and get to know Beata K? Yes
How many doctors did you speak to about Maya? Two
Had ketamine worked in the past? Yes
Titrating – adjust the dose based on affect and side effects
Monitoring? Yes
Medically necessary? Yes
CRPS pain – describe to jury. Worst possible pain, number one cause of suicide from pain condition
I am board certified pain management/anesthesiologist, 25 years
Beata K was a concerned, attentive mother
How is she doing today? A-plus student
Last time ketamine? Oct 2016
Weight during the entire year of 2016? 27 kg (no weight gain at all, 9 year old child)
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Defense witness – Dr William Siessel, Physical Therapy
ACH currently has a CRPS pain clinic. He works on the inpatient side, also has outpatient side. At the time Maya was there, no specific CRPS pain clinic
Everything that I did with Maya back when she was here, is the same thing I do with patients in the official CRPS clinic.
What does “regional” mean to you as a therapist? Regional indicates one area of the body, such as a leg or arm, not a global full body syndrome
Do you have any recollection of treatment of Maya? Yes, she was easy to get along with, very pleasant. There were very distinct inconsistencies with how she presented and how she participated in therapy. Oftentimes she would refuse to do things during therapy sessions, but she did those things the day before and previous sessions. She was very resistant to any education I tried to provide to her on what we are doing and why we are doing it.
he personally provided 21 separate sessions and over 20 hours of time with her. Who else, Elizabeth Harper.
It was very spleasant as far as her personality. I would enter her room, see how she was doing, talk about the plan for that day, I would give her some goals. She often pushed back on the goals, but we tried to work together to set goals to try to improve her function. I didn’t try to push her too much or ask her to do anything that is uncomfortable. We try to get the patients to “buy in” so that they can make improvement, whether short or long period of time.
Game plan – yes, so initially someone else performed the initial eval. I reviewed those. We are always assessing, and always adjusting. With a view to try to get her back to normal life. Yu are always reassessing how they are today as opposed to yesterday. Tailoring treatments
Maya’s initial evaluation there are some areas of significant improvement. One area we worked on was her sitting balance. When first evaluated, she needed 50% effort from the therapist just to maintain sitting. Not even doing activities, just to sit up for 2 minutes. By the time she left the hospital she was able to sit up in her wheelchair with no back support or other support. She could participate in activies like games, grabbing things from the floor.
Another area of improvement was her sitting posture. On evaluation she was in a slumped posture unable to hold herself up and complaining of back pain whenever she straightened up. By the end she consistently had an upright posture, able to hold her torso and head up with a straight spine and no consistent complaints of pain.
The third area of improvement was her tolerance to higher levels of activity. Again on eval all she could do was sit on the side of the bed, with significant support, for 2 minutes. That was the maximum level of activity she was able to do. Throughout the entire time she was there she participated in various activities for over an hour at a time.
Those are significant gains in functionality.
Dynamic sitting balance – From PT perspective, we break into static and dynamic. Static is sitting without doing anything. Dynamic is how well you sit while doing things like catching a ball, reaching for things, doing other things
Regarding inconsistencies – often I would ask her to do something like to assist in getting herself sitting up in bed, or, let’s sit with our feet on the ground and reach for something. She would often say I can’t do that, I can’t do that, she would resist and maybe say it will be too painful. But then moments later we might be conversation or she would be doing something else and I would notice that she is now sitting up straight with her feet on the ground, not leaning over, having zero difficulty with sitting balance.
Exhibit – PT progress note 11/30/2016 – Indicates that patient refuses to participate in any therapeutic activities in rehab gym today. Is this an example of the type of sitting balance inconsistency you were talking about? Yes. There are specialty equipment in the gym, we had a conversation about the benefits of going to the gym, but she still refused. So instead I took her downstairs to the piano on first floor. While down there she could play without difficulty. That involves sitting up straight, reaching forward, keeping herself completely balanced without assistance, and she had no problem at all doing that. No sign of distress, no facial grimace. Bilateral lower extremities (both legs) were in full extension with full movement. Means she was kicking her legs all the way straight. This is something she consistently claimed she could not do. We rarely if ever saw her able to do this. It was completely controlled, which suggests more muscle strength than she is able to demonstrate when “trying” to do things or asked to do things.
When I brought attention to this I was trying to encourage her that “wow, look, you are doing really well and pointing out the things she was able to do, she immediately was unable to continue doing this, she stopped moving her legs completely and we never saw that again this day.
It’s significant because this is already a month or more into her therapy she had every day refused to do anything with her legs. Being able to see her able to do this with no visible signs of pain and no audible complaints of pain is significant.
Pull of a video – She is playing the piano in the lobby. An older doctor is playing with her. Several things stand out. She is sitting up straight, she has moved the trunk forward and not using back support. Both of her arms are being held up by her own effort, she is not resting them on anything, She is forward on the keys. Using core and back muscles to maintain the posture. At the very end she moves the wheelchair using her feet to move the wheelchair. Nobody helped her. Her feet are flat on the ground the whole time. She is smiling. When asked to anything similar to this she always said it’s too painful to do any of these things.
Distractibility – Means that their attention can be moved away from their perception or focus on pain. We used distraction with Maya, it was the only non-pharmacological tool that was effective with Maya. Frequeuntly we would engage in conversation and immediately she would forget all about being in pain. We used games and other external things to put her mind on other things. (I will just say here that the severity of CRPS pain makes it an “undistractible” level of pain. No matter what anyone tries to do, someone not being treated for CRPS will not be able to be distracted by it. If someone doused you with gasoline and set you on fire, simply talking to you would not make you think everything is OK and you aren’t feeling what you are feeling)
Exhibit – PT note from ACH 12/3/2016 He reads the note to see what stands out to him about this visit. The big thing is with her aunt present, her presentation was very different than other sessions. Usually we could use distraction techniques and she would be able to participate fully, didn’t have issues with balance. She was fine until her aunt showed up. With family present, when we put her on parallel bars she leaned all the way over and said she couldn’t do it. Once we pulled out a card game, she could manipulate the pieces with fine motor skills, but then once we put her back on the bars she again leaned over like she couldn’t balance herself. She had progressed up to this point of being able to do this on her own, but with family present was not able to do it all the sudden. Nothing had changed, the only thing new was the presence of her aunt.
He never told Maya her pain was not real. He would never say that to a pediatric patient or an adult. Whenever a patients says they have pain, he takes them at their word. He grades every exercise as to what they can tolerate.
As the hospitalization progressed she went from 6 sessions per week down to 3 per week. In the beginning she was willing to try, she was willing to participate. There came a time only a few sessions in where she just refused to try. The amount of improvement we were going to make reached a plateau. We did really well on sitting balance, but when it came to doing anything with her legs she simply wouldn’t try. We were watching and trying to encourage her to try, and were willing to increase the PT back up if we saw any effort on her part to start making progress in the areas that she still needed. But that didn’t happen, she just wasn’t willing to put in the effort.
He never saw Maya’s feet in the dystonic position. Every time he observed her, her feet were in the normal straight position. Always relaxed kind of pointed down.
There were frequent time when we were trying to educate her on why we use PT for CRPS,she would resist and frequently say “ this treatment isn’t going to work, this isn’t the treatment I need, I only need ketamine,. That is the only thing that is going to work”. She said that multiple times. I would just try to help her understand about the role of PT.
He saw her legs often in the “Indian style” position. He always wondered how did she get into that position, because she refused to use her legs in front of him. She would complain about allodynia in her legs (and all over) but somehow she was tolerating sitting in that position. Any touch to her legs would get screams, but she could have her legs on top of each other.
She wore a variety of clothing, shorts, pants, leggings. Same kind of thing. She couldn’t tolerate me trying to help her do a leg kick, insisted that anything touching her hurt. But she wore these tight leggings with no issue (I would be tearing the leggings of within 3 seconds if not less)
He never gave up on Maya. My goal was to help her get better. Wanted her to leave the hospital walking, get back to school, that is what we all enjoy. We get into this profession for that very reason, to se them go back to participating in normal activities is why we do what we do.
At the very end he noted that she displays functional strength to complete tasks, but when asked to do things she actively acts with impaired function. (I hate when the camera goes to Mr K. I originally thought he was just a quiet, bulldozed by mom, nice man. He’s an asshole. She tries to intimidate female witnesses by staring them down. This witness is a man, and he smirks at the male witnesses. He sits right next to the jury box)
Judge is apparently not going to allow him to explain his notation. That notation seems to imply that by the time of her release he was convinced that her physical disabilities were at least partially purposeful)
Plaintiff
His recollection was the initial diagnosis in her chart was CRPS, and he was not using confirmation bias on his work with her
I don’t recall seeing conversion disorder in her file.
At the beginning she was willing to attempt therapy. She never declined a therapy session due to “pain”. Whenever she declined a session it was because she was convinced she had a condition for which ketamine was the only effective treatment. She only mentioned pain after agreeing to a session and then saying she can’t do certain movements because of pain. When distracted with an activity that used the same movement, she could attempt it without complaining of pain. Her pain was distractibale.
My recollection the diagnosis was CRPS and I had no other information other than that. My impressions of her were based on my personal interactions with her.
He’s challenging the PT to produce photos of her doing things that she claimed not be be able to do things. He says he has his records that clearly indicate complete with details the specific things that he attempted to do that she said she couldn’t do, and then observations of her doing those things while playing or while in her room, or even while in the PT room while she was not aware that the activity they were doing was using those same muscles or strengths.
Did you get the same memo the last witness did? I don’t know.
Yesterday I got an outline of topics I might be asked. They asked me to look through my records to refresh my recollection of working with Maya. My records were written at the time, I didn’t just write them yesterday.
He was never asked to look for signs of conversion disorder. At the bottom of his note dated 1/6 he had noted that he was informed of an additional diagnosis, and he noted it in his record. He says that his treatment of patients are determined by medical diagnosis and if the medical diagnosis changes, he needs to know about it and he notes it.
Maya’s main complaint was global pain. We got her out of the wheelchair quite a bit during therapy. With assistance, yes. Video of PT in her room. He brings over a walker, Tells her to try to keep her feet flat on the ground. She whimpers while shuffling. She only takes a couple of mini steps and they help her to a chair. He encourages her and tells her that is an improvement since the last time and he’s proud of her. At this point in time she required a significant amount of help to transfer from bed to chair or from any other surface. (he never said she made progress in her legs
Asking if he knows Rachel Dionne at Agility Fitness – he says no. He agrees they never were able to get her to do anything with her legs.
Maya would exhibit spasms in her thighs – I don’t recall seeing spasms in her thighs. Bringing up a note. He explains that she had quad spasms in her legs when he passively moved her legs, which means she was not helping. He lifted them up to work on a range of motion and also put them back. She was not using any muscles at the time, he was doing all the work of moving her legs. Quads are muscles in the top of the legs.
In this instance it’s true that her large muscles had spasms when he moved them for her. (His demeanor was very shaken right from the beginning of Anderson’s questioning, which makes him look less confident. Anderson is good at intimidating witnesses)
Spasms can be indicative of many things. If your legs are very weak, which we know Maya’s legs were extremely weak, they will easily spasm on an attempt to use them. Quad spasms are involuntary. (I see where he’s going. He is stuck on accusing the hospital of claiming that Maya “can walk”. Nobody at the hospital ever said that. What they have consistently said is that she claimed to not be able to do things that they were able to observe her doing when she wasn’t thinking about it or knowing she was being observed)
This is a passive movement so she was not activating any of these muscles herself. She complained of pain and this was the only time he ever saw spasms in her legs. That was why it was notable.
He disagrees that Maya ws not doing well at all at the end.
He says again that many things did improve. They did not get her walking again. The treatment diagnosis was the same, we were still addressing all these things, but that does no mean that she didn’t make the gains that we noted. She was willing to try whatever she was agreeable to. Every session there were things she would not agree to do, so we worked on the things she agreed to work on. It wasn’t always pain that she used for her reason for not working on things. She often said that she did not believe PT was what she needed, she only wanted the ketamine. (I bet she did, no argument there)
She would not push herself past the point where she was comfortable with. I can’t say what she was thinking. Calls for speculation. This is the one where she is trying to slap her legs to move them. She is pounding them with her fist and trying to pull and push her legs with her arms. She’s making a huge drama about it. Giddyup horsey she keeps repeating. Her mother is in the room.
He agrees that she appears to be trying. (YMMV) He explains the foot thingys are to prevent foot drag. The jury has seen multiple photos of her feet in dystonic position. He says when her feet are hanging in the down position that is called foot drop and it’s caused by muscle weakness in the front of the leg. Dystonia is something else and he never say that the whole time Maya was in the hospital. He says dystonia has to do with the calf muscles interacting with nerves where the foot is maintained in a fixed position. That is not what he saw with Maya.
Why is it that every other therapist saw Maya with dystonia both before and after ACH? Objection sustained.
LOL Attorney just said that other therapist did see CONVERSION and everyone saw CONVERSION. Freudian slip maybe?
He says Maya’s feet were always in the down relaxed position and whenever her feet touched the ground the ankles were always flexible and her feet would end up flat on the ground. (You can see that in the video of her playing the piano even)
Dystonia means your feet are locked, very little can be done to move them. Even maximal force would no move the feet into a different position if it was dystonia.
I am not saying she was “trying” to keep her feet inthat position. Her foot position is normal for all of us.
I personally do not recall looking for signs of paralysis. My job as a PT is to find ways to help the patient regain physical function. Weakness, decreased range of motion, things like that. I do not make a medical diagnosis in my job.
My experience with CRPS is that paralysis is not a symptom I have ever seen. When asked to do a leg kick she would say she can’t. I never disbelieved her claims of pain. I take those at face value.
By the time she left she had to slump over in her wheelchair? No, she had achieved core strength and was sitting up by that time.
He’s going to show a photo of her slumping I guess on 1/4/2017. It does say Maya said she couldn’t sit up on that say and she slumped over while getting into the wheelchair. But that was not her usual state by that date in time. She was consistently sitting up
He repeats the improvements. 3 main areas – sitting balance, sit independently, this was consistent by the time of the end. Her posture was more upright with no assistance and no claims of pain while doing an activity while sitting up. Activity tolerance. She went from 2 minutes of sitting with extensive help. At the end she was playing games for more than an hour at a time, and she would be able to sit in various positions. We wished that we could have helped to her to walk again, I was disappointed that didn’t happen, but we did our best to help Maya regain as much functionality as possible
Muscle spasm – you also said spasm can be a sign of weakness, can you explain that? If a patient is in a wheelchair since July 4, 2015 could they have the kind of weakness that cause cause spasms. Yes, he explains that once a leg hasn’t moved in a long time you often see this.
Final PT note – 1/4/2017 – Under other assessment and goals. She displays the functional strength to complete tasks but when specifically asked to complete activities she actively presents with impaired function. (This is the one the judge would not allow him to expand on earlier, maybe a door was opened)
What does this mean? Functional strength means enough strength to perform activities. Throughout all these notes, it’s been noted that she has the strength to hold herself up, reach, do all kinds of things. She could bend all the way forward to pick something up off the ground without any assistance. So, he ahs the strength in her mscles to do all these things. Her core, arms, especially. And when distracted, she does them. She even moves her legs to reposition herself. But when asked to do something, she actively presents with impaired function. That was a very consistent inconsistency we found throughout her time with us.
He doesn’t recall when his very last note was.
Exhibit 1/11/2017 – Do you agree she was doing decreased level of activity. Are you noting decrease activity. No, I am noting a decrease in her participation and attempt to do things. Not a decrease in functionality.
ACH currently has a CRPS pain clinic. He works on the inpatient side, also has outpatient side. At the time Maya was there, no specific CRPS pain clinic
Everything that I did with Maya back when she was here, is the same thing I do with patients in the official CRPS clinic.
What does “regional” mean to you as a therapist? Regional indicates one area of the body, such as a leg or arm, not a global full body syndrome
Do you have any recollection of treatment of Maya? Yes, she was easy to get along with, very pleasant. There were very distinct inconsistencies with how she presented and how she participated in therapy. Oftentimes she would refuse to do things during therapy sessions, but she did those things the day before and previous sessions. She was very resistant to any education I tried to provide to her on what we are doing and why we are doing it.
he personally provided 21 separate sessions and over 20 hours of time with her. Who else, Elizabeth Harper.
It was very spleasant as far as her personality. I would enter her room, see how she was doing, talk about the plan for that day, I would give her some goals. She often pushed back on the goals, but we tried to work together to set goals to try to improve her function. I didn’t try to push her too much or ask her to do anything that is uncomfortable. We try to get the patients to “buy in” so that they can make improvement, whether short or long period of time.
Game plan – yes, so initially someone else performed the initial eval. I reviewed those. We are always assessing, and always adjusting. With a view to try to get her back to normal life. Yu are always reassessing how they are today as opposed to yesterday. Tailoring treatments
Maya’s initial evaluation there are some areas of significant improvement. One area we worked on was her sitting balance. When first evaluated, she needed 50% effort from the therapist just to maintain sitting. Not even doing activities, just to sit up for 2 minutes. By the time she left the hospital she was able to sit up in her wheelchair with no back support or other support. She could participate in activies like games, grabbing things from the floor.
Another area of improvement was her sitting posture. On evaluation she was in a slumped posture unable to hold herself up and complaining of back pain whenever she straightened up. By the end she consistently had an upright posture, able to hold her torso and head up with a straight spine and no consistent complaints of pain.
The third area of improvement was her tolerance to higher levels of activity. Again on eval all she could do was sit on the side of the bed, with significant support, for 2 minutes. That was the maximum level of activity she was able to do. Throughout the entire time she was there she participated in various activities for over an hour at a time.
Those are significant gains in functionality.
Dynamic sitting balance – From PT perspective, we break into static and dynamic. Static is sitting without doing anything. Dynamic is how well you sit while doing things like catching a ball, reaching for things, doing other things
Regarding inconsistencies – often I would ask her to do something like to assist in getting herself sitting up in bed, or, let’s sit with our feet on the ground and reach for something. She would often say I can’t do that, I can’t do that, she would resist and maybe say it will be too painful. But then moments later we might be conversation or she would be doing something else and I would notice that she is now sitting up straight with her feet on the ground, not leaning over, having zero difficulty with sitting balance.
Exhibit – PT progress note 11/30/2016 – Indicates that patient refuses to participate in any therapeutic activities in rehab gym today. Is this an example of the type of sitting balance inconsistency you were talking about? Yes. There are specialty equipment in the gym, we had a conversation about the benefits of going to the gym, but she still refused. So instead I took her downstairs to the piano on first floor. While down there she could play without difficulty. That involves sitting up straight, reaching forward, keeping herself completely balanced without assistance, and she had no problem at all doing that. No sign of distress, no facial grimace. Bilateral lower extremities (both legs) were in full extension with full movement. Means she was kicking her legs all the way straight. This is something she consistently claimed she could not do. We rarely if ever saw her able to do this. It was completely controlled, which suggests more muscle strength than she is able to demonstrate when “trying” to do things or asked to do things.
When I brought attention to this I was trying to encourage her that “wow, look, you are doing really well and pointing out the things she was able to do, she immediately was unable to continue doing this, she stopped moving her legs completely and we never saw that again this day.
It’s significant because this is already a month or more into her therapy she had every day refused to do anything with her legs. Being able to see her able to do this with no visible signs of pain and no audible complaints of pain is significant.
Pull of a video – She is playing the piano in the lobby. An older doctor is playing with her. Several things stand out. She is sitting up straight, she has moved the trunk forward and not using back support. Both of her arms are being held up by her own effort, she is not resting them on anything, She is forward on the keys. Using core and back muscles to maintain the posture. At the very end she moves the wheelchair using her feet to move the wheelchair. Nobody helped her. Her feet are flat on the ground the whole time. She is smiling. When asked to anything similar to this she always said it’s too painful to do any of these things.
Distractibility – Means that their attention can be moved away from their perception or focus on pain. We used distraction with Maya, it was the only non-pharmacological tool that was effective with Maya. Frequeuntly we would engage in conversation and immediately she would forget all about being in pain. We used games and other external things to put her mind on other things. (I will just say here that the severity of CRPS pain makes it an “undistractible” level of pain. No matter what anyone tries to do, someone not being treated for CRPS will not be able to be distracted by it. If someone doused you with gasoline and set you on fire, simply talking to you would not make you think everything is OK and you aren’t feeling what you are feeling)
Exhibit – PT note from ACH 12/3/2016 He reads the note to see what stands out to him about this visit. The big thing is with her aunt present, her presentation was very different than other sessions. Usually we could use distraction techniques and she would be able to participate fully, didn’t have issues with balance. She was fine until her aunt showed up. With family present, when we put her on parallel bars she leaned all the way over and said she couldn’t do it. Once we pulled out a card game, she could manipulate the pieces with fine motor skills, but then once we put her back on the bars she again leaned over like she couldn’t balance herself. She had progressed up to this point of being able to do this on her own, but with family present was not able to do it all the sudden. Nothing had changed, the only thing new was the presence of her aunt.
He never told Maya her pain was not real. He would never say that to a pediatric patient or an adult. Whenever a patients says they have pain, he takes them at their word. He grades every exercise as to what they can tolerate.
As the hospitalization progressed she went from 6 sessions per week down to 3 per week. In the beginning she was willing to try, she was willing to participate. There came a time only a few sessions in where she just refused to try. The amount of improvement we were going to make reached a plateau. We did really well on sitting balance, but when it came to doing anything with her legs she simply wouldn’t try. We were watching and trying to encourage her to try, and were willing to increase the PT back up if we saw any effort on her part to start making progress in the areas that she still needed. But that didn’t happen, she just wasn’t willing to put in the effort.
He never saw Maya’s feet in the dystonic position. Every time he observed her, her feet were in the normal straight position. Always relaxed kind of pointed down.
There were frequent time when we were trying to educate her on why we use PT for CRPS,she would resist and frequently say “ this treatment isn’t going to work, this isn’t the treatment I need, I only need ketamine,. That is the only thing that is going to work”. She said that multiple times. I would just try to help her understand about the role of PT.
He saw her legs often in the “Indian style” position. He always wondered how did she get into that position, because she refused to use her legs in front of him. She would complain about allodynia in her legs (and all over) but somehow she was tolerating sitting in that position. Any touch to her legs would get screams, but she could have her legs on top of each other.
She wore a variety of clothing, shorts, pants, leggings. Same kind of thing. She couldn’t tolerate me trying to help her do a leg kick, insisted that anything touching her hurt. But she wore these tight leggings with no issue (I would be tearing the leggings of within 3 seconds if not less)
He never gave up on Maya. My goal was to help her get better. Wanted her to leave the hospital walking, get back to school, that is what we all enjoy. We get into this profession for that very reason, to se them go back to participating in normal activities is why we do what we do.
At the very end he noted that she displays functional strength to complete tasks, but when asked to do things she actively acts with impaired function. (I hate when the camera goes to Mr K. I originally thought he was just a quiet, bulldozed by mom, nice man. He’s an asshole. She tries to intimidate female witnesses by staring them down. This witness is a man, and he smirks at the male witnesses. He sits right next to the jury box)
Judge is apparently not going to allow him to explain his notation. That notation seems to imply that by the time of her release he was convinced that her physical disabilities were at least partially purposeful)
Plaintiff
His recollection was the initial diagnosis in her chart was CRPS, and he was not using confirmation bias on his work with her
I don’t recall seeing conversion disorder in her file.
At the beginning she was willing to attempt therapy. She never declined a therapy session due to “pain”. Whenever she declined a session it was because she was convinced she had a condition for which ketamine was the only effective treatment. She only mentioned pain after agreeing to a session and then saying she can’t do certain movements because of pain. When distracted with an activity that used the same movement, she could attempt it without complaining of pain. Her pain was distractibale.
My recollection the diagnosis was CRPS and I had no other information other than that. My impressions of her were based on my personal interactions with her.
He’s challenging the PT to produce photos of her doing things that she claimed not be be able to do things. He says he has his records that clearly indicate complete with details the specific things that he attempted to do that she said she couldn’t do, and then observations of her doing those things while playing or while in her room, or even while in the PT room while she was not aware that the activity they were doing was using those same muscles or strengths.
Did you get the same memo the last witness did? I don’t know.
Yesterday I got an outline of topics I might be asked. They asked me to look through my records to refresh my recollection of working with Maya. My records were written at the time, I didn’t just write them yesterday.
He was never asked to look for signs of conversion disorder. At the bottom of his note dated 1/6 he had noted that he was informed of an additional diagnosis, and he noted it in his record. He says that his treatment of patients are determined by medical diagnosis and if the medical diagnosis changes, he needs to know about it and he notes it.
Maya’s main complaint was global pain. We got her out of the wheelchair quite a bit during therapy. With assistance, yes. Video of PT in her room. He brings over a walker, Tells her to try to keep her feet flat on the ground. She whimpers while shuffling. She only takes a couple of mini steps and they help her to a chair. He encourages her and tells her that is an improvement since the last time and he’s proud of her. At this point in time she required a significant amount of help to transfer from bed to chair or from any other surface. (he never said she made progress in her legs
Asking if he knows Rachel Dionne at Agility Fitness – he says no. He agrees they never were able to get her to do anything with her legs.
Maya would exhibit spasms in her thighs – I don’t recall seeing spasms in her thighs. Bringing up a note. He explains that she had quad spasms in her legs when he passively moved her legs, which means she was not helping. He lifted them up to work on a range of motion and also put them back. She was not using any muscles at the time, he was doing all the work of moving her legs. Quads are muscles in the top of the legs.
In this instance it’s true that her large muscles had spasms when he moved them for her. (His demeanor was very shaken right from the beginning of Anderson’s questioning, which makes him look less confident. Anderson is good at intimidating witnesses)
Spasms can be indicative of many things. If your legs are very weak, which we know Maya’s legs were extremely weak, they will easily spasm on an attempt to use them. Quad spasms are involuntary. (I see where he’s going. He is stuck on accusing the hospital of claiming that Maya “can walk”. Nobody at the hospital ever said that. What they have consistently said is that she claimed to not be able to do things that they were able to observe her doing when she wasn’t thinking about it or knowing she was being observed)
This is a passive movement so she was not activating any of these muscles herself. She complained of pain and this was the only time he ever saw spasms in her legs. That was why it was notable.
He disagrees that Maya ws not doing well at all at the end.
He says again that many things did improve. They did not get her walking again. The treatment diagnosis was the same, we were still addressing all these things, but that does no mean that she didn’t make the gains that we noted. She was willing to try whatever she was agreeable to. Every session there were things she would not agree to do, so we worked on the things she agreed to work on. It wasn’t always pain that she used for her reason for not working on things. She often said that she did not believe PT was what she needed, she only wanted the ketamine. (I bet she did, no argument there)
She would not push herself past the point where she was comfortable with. I can’t say what she was thinking. Calls for speculation. This is the one where she is trying to slap her legs to move them. She is pounding them with her fist and trying to pull and push her legs with her arms. She’s making a huge drama about it. Giddyup horsey she keeps repeating. Her mother is in the room.
He agrees that she appears to be trying. (YMMV) He explains the foot thingys are to prevent foot drag. The jury has seen multiple photos of her feet in dystonic position. He says when her feet are hanging in the down position that is called foot drop and it’s caused by muscle weakness in the front of the leg. Dystonia is something else and he never say that the whole time Maya was in the hospital. He says dystonia has to do with the calf muscles interacting with nerves where the foot is maintained in a fixed position. That is not what he saw with Maya.
Why is it that every other therapist saw Maya with dystonia both before and after ACH? Objection sustained.
LOL Attorney just said that other therapist did see CONVERSION and everyone saw CONVERSION. Freudian slip maybe?
He says Maya’s feet were always in the down relaxed position and whenever her feet touched the ground the ankles were always flexible and her feet would end up flat on the ground. (You can see that in the video of her playing the piano even)
Dystonia means your feet are locked, very little can be done to move them. Even maximal force would no move the feet into a different position if it was dystonia.
I am not saying she was “trying” to keep her feet inthat position. Her foot position is normal for all of us.
I personally do not recall looking for signs of paralysis. My job as a PT is to find ways to help the patient regain physical function. Weakness, decreased range of motion, things like that. I do not make a medical diagnosis in my job.
My experience with CRPS is that paralysis is not a symptom I have ever seen. When asked to do a leg kick she would say she can’t. I never disbelieved her claims of pain. I take those at face value.
By the time she left she had to slump over in her wheelchair? No, she had achieved core strength and was sitting up by that time.
He’s going to show a photo of her slumping I guess on 1/4/2017. It does say Maya said she couldn’t sit up on that say and she slumped over while getting into the wheelchair. But that was not her usual state by that date in time. She was consistently sitting up
He repeats the improvements. 3 main areas – sitting balance, sit independently, this was consistent by the time of the end. Her posture was more upright with no assistance and no claims of pain while doing an activity while sitting up. Activity tolerance. She went from 2 minutes of sitting with extensive help. At the end she was playing games for more than an hour at a time, and she would be able to sit in various positions. We wished that we could have helped to her to walk again, I was disappointed that didn’t happen, but we did our best to help Maya regain as much functionality as possible
Muscle spasm – you also said spasm can be a sign of weakness, can you explain that? If a patient is in a wheelchair since July 4, 2015 could they have the kind of weakness that cause cause spasms. Yes, he explains that once a leg hasn’t moved in a long time you often see this.
Final PT note – 1/4/2017 – Under other assessment and goals. She displays the functional strength to complete tasks but when specifically asked to complete activities she actively presents with impaired function. (This is the one the judge would not allow him to expand on earlier, maybe a door was opened)
What does this mean? Functional strength means enough strength to perform activities. Throughout all these notes, it’s been noted that she has the strength to hold herself up, reach, do all kinds of things. She could bend all the way forward to pick something up off the ground without any assistance. So, he ahs the strength in her mscles to do all these things. Her core, arms, especially. And when distracted, she does them. She even moves her legs to reposition herself. But when asked to do something, she actively presents with impaired function. That was a very consistent inconsistency we found throughout her time with us.
He doesn’t recall when his very last note was.
Exhibit 1/11/2017 – Do you agree she was doing decreased level of activity. Are you noting decrease activity. No, I am noting a decrease in her participation and attempt to do things. Not a decrease in functionality.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Defense witness – Dr William Siessel, Physical Therapy
ACH currently has a CRPS pain clinic. He works on the inpatient side, also has outpatient side. At the time Maya was there, no specific CRPS pain clinic
Everything that I did with Maya back when she was here, is the same thing I do with patients in the official CRPS clinic.
What does “regional” mean to you as a therapist? Regional indicates one area of the body, such as a leg or arm, not a global full body syndrome
Do you have any recollection of treatment of Maya? Yes, she was easy to get along with, very pleasant. There were very distinct inconsistencies with how she presented and how she participated in therapy. Oftentimes she would refuse to do things during therapy sessions, but she did those things the day before and previous sessions. She was very resistant to any education I tried to provide to her on what we are doing and why we are doing it.
he personally provided 21 separate sessions and over 20 hours of time with her. Who else, Elizabeth Harper.
It was very spleasant as far as her personality. I would enter her room, see how she was doing, talk about the plan for that day, I would give her some goals. She often pushed back on the goals, but we tried to work together to set goals to try to improve her function. I didn’t try to push her too much or ask her to do anything that is uncomfortable. We try to get the patients to “buy in” so that they can make improvement, whether short or long period of time.
Game plan – yes, so initially someone else performed the initial eval. I reviewed those. We are always assessing, and always adjusting. With a view to try to get her back to normal life. Yu are always reassessing how they are today as opposed to yesterday. Tailoring treatments
Maya’s initial evaluation there are some areas of significant improvement. One area we worked on was her sitting balance. When first evaluated, she needed 50% effort from the therapist just to maintain sitting. Not even doing activities, just to sit up for 2 minutes. By the time she left the hospital she was able to sit up in her wheelchair with no back support or other support. She could participate in activies like games, grabbing things from the floor.
Another area of improvement was her sitting posture. On evaluation she was in a slumped posture unable to hold herself up and complaining of back pain whenever she straightened up. By the end she consistently had an upright posture, able to hold her torso and head up with a straight spine and no consistent complaints of pain.
The third area of improvement was her tolerance to higher levels of activity. Again on eval all she could do was sit on the side of the bed, with significant support, for 2 minutes. That was the maximum level of activity she was able to do. Throughout the entire time she was there she participated in various activities for over an hour at a time.
Those are significant gains in functionality.
Dynamic sitting balance – From PT perspective, we break into static and dynamic. Static is sitting without doing anything. Dynamic is how well you sit while doing things like catching a ball, reaching for things, doing other things
Regarding inconsistencies – often I would ask her to do something like to assist in getting herself sitting up in bed, or, let’s sit with our feet on the ground and reach for something. She would often say I can’t do that, I can’t do that, she would resist and maybe say it will be too painful. But then moments later we might be conversation or she would be doing something else and I would notice that she is now sitting up straight with her feet on the ground, not leaning over, having zero difficulty with sitting balance.
Exhibit – PT progress note 11/30/2016 – Indicates that patient refuses to participate in any therapeutic activities in rehab gym today. Is this an example of the type of sitting balance inconsistency you were talking about? Yes. There are specialty equipment in the gym, we had a conversation about the benefits of going to the gym, but she still refused. So instead I took her downstairs to the piano on first floor. While down there she could play without difficulty. That involves sitting up straight, reaching forward, keeping herself completely balanced without assistance, and she had no problem at all doing that. No sign of distress, no facial grimace. Bilateral lower extremities (both legs) were in full extension with full movement. Means she was kicking her legs all the way straight. This is something she consistently claimed she could not do. We rarely if ever saw her able to do this. It was completely controlled, which suggests more muscle strength than she is able to demonstrate when “trying” to do things or asked to do things.
When I brought attention to this I was trying to encourage her that “wow, look, you are doing really well and pointing out the things she was able to do, she immediately was unable to continue doing this, she stopped moving her legs completely and we never saw that again this day.
It’s significant because this is already a month or more into her therapy she had every day refused to do anything with her legs. Being able to see her able to do this with no visible signs of pain and no audible complaints of pain is significant.
Pull of a video – She is playing the piano in the lobby. An older doctor is playing with her. Several things stand out. She is sitting up straight, she has moved the trunk forward and not using back support. Both of her arms are being held up by her own effort, she is not resting them on anything, She is forward on the keys. Using core and back muscles to maintain the posture. At the very end she moves the wheelchair using her feet to move the wheelchair. Nobody helped her. Her feet are flat on the ground the whole time. She is smiling. When asked to anything similar to this she always said it’s too painful to do any of these things.
Distractibility – Means that their attention can be moved away from their perception or focus on pain. We used distraction with Maya, it was the only non-pharmacological tool that was effective with Maya. Frequeuntly we would engage in conversation and immediately she would forget all about being in pain. We used games and other external things to put her mind on other things. (I will just say here that the severity of CRPS pain makes it an “undistractible” level of pain. No matter what anyone tries to do, someone not being treated for CRPS will not be able to be distracted by it. If someone doused you with gasoline and set you on fire, simply talking to you would not make you think everything is OK and you aren’t feeling what you are feeling)
Exhibit – PT note from ACH 12/3/2016 He reads the note to see what stands out to him about this visit. The big thing is with her aunt present, her presentation was very different than other sessions. Usually we could use distraction techniques and she would be able to participate fully, didn’t have issues with balance. She was fine until her aunt showed up. With family present, when we put her on parallel bars she leaned all the way over and said she couldn’t do it. Once we pulled out a card game, she could manipulate the pieces with fine motor skills, but then once we put her back on the bars she again leaned over like she couldn’t balance herself. She had progressed up to this point of being able to do this on her own, but with family present was not able to do it all the sudden. Nothing had changed, the only thing new was the presence of her aunt.
He never told Maya her pain was not real. He would never say that to a pediatric patient or an adult. Whenever a patients says they have pain, he takes them at their word. He grades every exercise as to what they can tolerate.
As the hospitalization progressed she went from 6 sessions per week down to 3 per week. In the beginning she was willing to try, she was willing to participate. There came a time only a few sessions in where she just refused to try. The amount of improvement we were going to make reached a plateau. We did really well on sitting balance, but when it came to doing anything with her legs she simply wouldn’t try. We were watching and trying to encourage her to try, and were willing to increase the PT back up if we saw any effort on her part to start making progress in the areas that she still needed. But that didn’t happen, she just wasn’t willing to put in the effort.
He never saw Maya’s feet in the dystonic position. Every time he observed her, her feet were in the normal straight position. Always relaxed kind of pointed down.
There were frequent time when we were trying to educate her on why we use PT for CRPS,she would resist and frequently say “ this treatment isn’t going to work, this isn’t the treatment I need, I only need ketamine,. That is the only thing that is going to work”. She said that multiple times. I would just try to help her understand about the role of PT.
He saw her legs often in the “Indian style” position. He always wondered how did she get into that position, because she refused to use her legs in front of him. She would complain about allodynia in her legs (and all over) but somehow she was tolerating sitting in that position. Any touch to her legs would get screams, but she could have her legs on top of each other.
She wore a variety of clothing, shorts, pants, leggings. Same kind of thing. She couldn’t tolerate me trying to help her do a leg kick, insisted that anything touching her hurt. But she wore these tight leggings with no issue (I would be tearing the leggings of within 3 seconds if not less)
He never gave up on Maya. My goal was to help her get better. Wanted her to leave the hospital walking, get back to school, that is what we all enjoy. We get into this profession for that very reason, to se them go back to participating in normal activities is why we do what we do.
At the very end he noted that she displays functional strength to complete tasks, but when asked to do things she actively acts with impaired function. (I hate when the camera goes to Mr K. I originally thought he was just a quiet, bulldozed by mom, nice man. He’s an asshole. She tries to intimidate female witnesses by staring them down. This witness is a man, and he smirks at the male witnesses. He sits right next to the jury box)
Judge is apparently not going to allow him to explain his notation. That notation seems to imply that by the time of her release he was convinced that her physical disabilities were at least partially purposeful)
Plaintiff
His recollection was the initial diagnosis in her chart was CRPS, and he was not using confirmation bias on his work with her
I don’t recall seeing conversion disorder in her file.
At the beginning she was willing to attempt therapy. She never declined a therapy session due to “pain”. Whenever she declined a session it was because she was convinced she had a condition for which ketamine was the only effective treatment. She only mentioned pain after agreeing to a session and then saying she can’t do certain movements because of pain. When distracted with an activity that used the same movement, she could attempt it without complaining of pain. Her pain was distractibale.
My recollection the diagnosis was CRPS and I had no other information other than that. My impressions of her were based on my personal interactions with her.
He’s challenging the PT to produce photos of her doing things that she claimed not be be able to do things. He says he has his records that clearly indicate complete with details the specific things that he attempted to do that she said she couldn’t do, and then observations of her doing those things while playing or while in her room, or even while in the PT room while she was not aware that the activity they were doing was using those same muscles or strengths.
Did you get the same memo the last witness did? I don’t know.
Yesterday I got an outline of topics I might be asked. They asked me to look through my records to refresh my recollection of working with Maya. My records were written at the time, I didn’t just write them yesterday.
He was never asked to look for signs of conversion disorder. At the bottom of his note dated 1/6 he had noted that he was informed of an additional diagnosis, and he noted it in his record. He says that his treatment of patients are determined by medical diagnosis and if the medical diagnosis changes, he needs to know about it and he notes it.
Maya’s main complaint was global pain. We got her out of the wheelchair quite a bit during therapy. With assistance, yes. Video of PT in her room. He brings over a walker, Tells her to try to keep her feet flat on the ground. She whimpers while shuffling. She only takes a couple of mini steps and they help her to a chair. He encourages her and tells her that is an improvement since the last time and he’s proud of her. At this point in time she required a significant amount of help to transfer from bed to chair or from any other surface. (he never said she made progress in her legs
Asking if he knows Rachel Dionne at Agility Fitness – he says no. He agrees they never were able to get her to do anything with her legs.
Maya would exhibit spasms in her thighs – I don’t recall seeing spasms in her thighs. Bringing up a note. He explains that she had quad spasms in her legs when he passively moved her legs, which means she was not helping. He lifted them up to work on a range of motion and also put them back. She was not using any muscles at the time, he was doing all the work of moving her legs. Quads are muscles in the top of the legs.
In this instance it’s true that her large muscles had spasms when he moved them for her. (His demeanor was very shaken right from the beginning of Anderson’s questioning, which makes him look less confident. Anderson is good at intimidating witnesses)
Spasms can be indicative of many things. If your legs are very weak, which we know Maya’s legs were extremely weak, they will easily spasm on an attempt to use them. Quad spasms are involuntary. (I see where he’s going. He is stuck on accusing the hospital of claiming that Maya “can walk”. Nobody at the hospital ever said that. What they have consistently said is that she claimed to not be able to do things that they were able to observe her doing when she wasn’t thinking about it or knowing she was being observed)
This is a passive movement so she was not activating any of these muscles herself. She complained of pain and this was the only time he ever saw spasms in her legs. That was why it was notable.
He disagrees that Maya ws not doing well at all at the end.
He says again that many things did improve. They did not get her walking again. The treatment diagnosis was the same, we were still addressing all these things, but that does no mean that she didn’t make the gains that we noted. She was willing to try whatever she was agreeable to. Every session there were things she would not agree to do, so we worked on the things she agreed to work on. It wasn’t always pain that she used for her reason for not working on things. She often said that she did not believe PT was what she needed, she only wanted the ketamine. (I bet she did, no argument there)
She would not push herself past the point where she was comfortable with. I can’t say what she was thinking. Calls for speculation. This is the one where she is trying to slap her legs to move them. She is pounding them with her fist and trying to pull and push her legs with her arms. She’s making a huge drama about it. Giddyup horsey she keeps repeating. Her mother is in the room.
He agrees that she appears to be trying. (YMMV) He explains the foot thingys are to prevent foot drag. The jury has seen multiple photos of her feet in dystonic position. He says when her feet are hanging in the down position that is called foot drop and it’s caused by muscle weakness in the front of the leg. Dystonia is something else and he never say that the whole time Maya was in the hospital. He says dystonia has to do with the calf muscles interacting with nerves where the foot is maintained in a fixed position. That is not what he saw with Maya.
Why is it that every other therapist saw Maya with dystonia both before and after ACH? Objection sustained.
LOL Attorney just said that other therapist did see CONVERSION and everyone saw CONVERSION. Freudian slip maybe?
He says Maya’s feet were always in the down relaxed position and whenever her feet touched the ground the ankles were always flexible and her feet would end up flat on the ground. (You can see that in the video of her playing the piano even)
Dystonia means your feet are locked, very little can be done to move them. Even maximal force would no move the feet into a different position if it was dystonia.
I am not saying she was “trying” to keep her feet inthat position. Her foot position is normal for all of us.
I personally do not recall looking for signs of paralysis. My job as a PT is to find ways to help the patient regain physical function. Weakness, decreased range of motion, things like that. I do not make a medical diagnosis in my job.
My experience with CRPS is that paralysis is not a symptom I have ever seen. When asked to do a leg kick she would say she can’t. I never disbelieved her claims of pain. I take those at face value.
By the time she left she had to slump over in her wheelchair? No, she had achieved core strength and was sitting up by that time.
He’s going to show a photo of her slumping I guess on 1/4/2017. It does say Maya said she couldn’t sit up on that say and she slumped over while getting into the wheelchair. But that was not her usual state by that date in time. She was consistently sitting up
He repeats the improvements. 3 main areas – sitting balance, sit independently, this was consistent by the time of the end. Her posture was more upright with no assistance and no claims of pain while doing an activity while sitting up. Activity tolerance. She went from 2 minutes of sitting with extensive help. At the end she was playing games for more than an hour at a time, and she would be able to sit in various positions. We wished that we could have helped to her to walk again, I was disappointed that didn’t happen, but we did our best to help Maya regain as much functionality as possible
Muscle spasm – you also said spasm can be a sign of weakness, can you explain that? If a patient is in a wheelchair since July 4, 2015 could they have the kind of weakness that cause cause spasms. Yes, he explains that once a leg hasn’t moved in a long time you often see this.
Final PT note – 1/4/2017 – Under other assessment and goals. She displays the functional strength to complete tasks but when specifically asked to complete activities she actively presents with impaired function. (This is the one the judge would not allow him to expand on earlier, maybe a door was opened)
What does this mean? Functional strength means enough strength to perform activities. Throughout all these notes, it’s been noted that she has the strength to hold herself up, reach, do all kinds of things. She could bend all the way forward to pick something up off the ground without any assistance. So, he ahs the strength in her mscles to do all these things. Her core, arms, especially. And when distracted, she does them. She even moves her legs to reposition herself. But when asked to do something, she actively presents with impaired function. That was a very consistent inconsistency we found throughout her time with us.
He doesn’t recall when his very last note was.
Exhibit 1/11/2017 – Do you agree she was doing decreased level of activity. Are you noting decrease activity. No, I am noting a decrease in her participation and attempt to do things. Not a decrease in functionality.
ACH currently has a CRPS pain clinic. He works on the inpatient side, also has outpatient side. At the time Maya was there, no specific CRPS pain clinic
Everything that I did with Maya back when she was here, is the same thing I do with patients in the official CRPS clinic.
What does “regional” mean to you as a therapist? Regional indicates one area of the body, such as a leg or arm, not a global full body syndrome
Do you have any recollection of treatment of Maya? Yes, she was easy to get along with, very pleasant. There were very distinct inconsistencies with how she presented and how she participated in therapy. Oftentimes she would refuse to do things during therapy sessions, but she did those things the day before and previous sessions. She was very resistant to any education I tried to provide to her on what we are doing and why we are doing it.
he personally provided 21 separate sessions and over 20 hours of time with her. Who else, Elizabeth Harper.
It was very spleasant as far as her personality. I would enter her room, see how she was doing, talk about the plan for that day, I would give her some goals. She often pushed back on the goals, but we tried to work together to set goals to try to improve her function. I didn’t try to push her too much or ask her to do anything that is uncomfortable. We try to get the patients to “buy in” so that they can make improvement, whether short or long period of time.
Game plan – yes, so initially someone else performed the initial eval. I reviewed those. We are always assessing, and always adjusting. With a view to try to get her back to normal life. Yu are always reassessing how they are today as opposed to yesterday. Tailoring treatments
Maya’s initial evaluation there are some areas of significant improvement. One area we worked on was her sitting balance. When first evaluated, she needed 50% effort from the therapist just to maintain sitting. Not even doing activities, just to sit up for 2 minutes. By the time she left the hospital she was able to sit up in her wheelchair with no back support or other support. She could participate in activies like games, grabbing things from the floor.
Another area of improvement was her sitting posture. On evaluation she was in a slumped posture unable to hold herself up and complaining of back pain whenever she straightened up. By the end she consistently had an upright posture, able to hold her torso and head up with a straight spine and no consistent complaints of pain.
The third area of improvement was her tolerance to higher levels of activity. Again on eval all she could do was sit on the side of the bed, with significant support, for 2 minutes. That was the maximum level of activity she was able to do. Throughout the entire time she was there she participated in various activities for over an hour at a time.
Those are significant gains in functionality.
Dynamic sitting balance – From PT perspective, we break into static and dynamic. Static is sitting without doing anything. Dynamic is how well you sit while doing things like catching a ball, reaching for things, doing other things
Regarding inconsistencies – often I would ask her to do something like to assist in getting herself sitting up in bed, or, let’s sit with our feet on the ground and reach for something. She would often say I can’t do that, I can’t do that, she would resist and maybe say it will be too painful. But then moments later we might be conversation or she would be doing something else and I would notice that she is now sitting up straight with her feet on the ground, not leaning over, having zero difficulty with sitting balance.
Exhibit – PT progress note 11/30/2016 – Indicates that patient refuses to participate in any therapeutic activities in rehab gym today. Is this an example of the type of sitting balance inconsistency you were talking about? Yes. There are specialty equipment in the gym, we had a conversation about the benefits of going to the gym, but she still refused. So instead I took her downstairs to the piano on first floor. While down there she could play without difficulty. That involves sitting up straight, reaching forward, keeping herself completely balanced without assistance, and she had no problem at all doing that. No sign of distress, no facial grimace. Bilateral lower extremities (both legs) were in full extension with full movement. Means she was kicking her legs all the way straight. This is something she consistently claimed she could not do. We rarely if ever saw her able to do this. It was completely controlled, which suggests more muscle strength than she is able to demonstrate when “trying” to do things or asked to do things.
When I brought attention to this I was trying to encourage her that “wow, look, you are doing really well and pointing out the things she was able to do, she immediately was unable to continue doing this, she stopped moving her legs completely and we never saw that again this day.
It’s significant because this is already a month or more into her therapy she had every day refused to do anything with her legs. Being able to see her able to do this with no visible signs of pain and no audible complaints of pain is significant.
Pull of a video – She is playing the piano in the lobby. An older doctor is playing with her. Several things stand out. She is sitting up straight, she has moved the trunk forward and not using back support. Both of her arms are being held up by her own effort, she is not resting them on anything, She is forward on the keys. Using core and back muscles to maintain the posture. At the very end she moves the wheelchair using her feet to move the wheelchair. Nobody helped her. Her feet are flat on the ground the whole time. She is smiling. When asked to anything similar to this she always said it’s too painful to do any of these things.
Distractibility – Means that their attention can be moved away from their perception or focus on pain. We used distraction with Maya, it was the only non-pharmacological tool that was effective with Maya. Frequeuntly we would engage in conversation and immediately she would forget all about being in pain. We used games and other external things to put her mind on other things. (I will just say here that the severity of CRPS pain makes it an “undistractible” level of pain. No matter what anyone tries to do, someone not being treated for CRPS will not be able to be distracted by it. If someone doused you with gasoline and set you on fire, simply talking to you would not make you think everything is OK and you aren’t feeling what you are feeling)
Exhibit – PT note from ACH 12/3/2016 He reads the note to see what stands out to him about this visit. The big thing is with her aunt present, her presentation was very different than other sessions. Usually we could use distraction techniques and she would be able to participate fully, didn’t have issues with balance. She was fine until her aunt showed up. With family present, when we put her on parallel bars she leaned all the way over and said she couldn’t do it. Once we pulled out a card game, she could manipulate the pieces with fine motor skills, but then once we put her back on the bars she again leaned over like she couldn’t balance herself. She had progressed up to this point of being able to do this on her own, but with family present was not able to do it all the sudden. Nothing had changed, the only thing new was the presence of her aunt.
He never told Maya her pain was not real. He would never say that to a pediatric patient or an adult. Whenever a patients says they have pain, he takes them at their word. He grades every exercise as to what they can tolerate.
As the hospitalization progressed she went from 6 sessions per week down to 3 per week. In the beginning she was willing to try, she was willing to participate. There came a time only a few sessions in where she just refused to try. The amount of improvement we were going to make reached a plateau. We did really well on sitting balance, but when it came to doing anything with her legs she simply wouldn’t try. We were watching and trying to encourage her to try, and were willing to increase the PT back up if we saw any effort on her part to start making progress in the areas that she still needed. But that didn’t happen, she just wasn’t willing to put in the effort.
He never saw Maya’s feet in the dystonic position. Every time he observed her, her feet were in the normal straight position. Always relaxed kind of pointed down.
There were frequent time when we were trying to educate her on why we use PT for CRPS,she would resist and frequently say “ this treatment isn’t going to work, this isn’t the treatment I need, I only need ketamine,. That is the only thing that is going to work”. She said that multiple times. I would just try to help her understand about the role of PT.
He saw her legs often in the “Indian style” position. He always wondered how did she get into that position, because she refused to use her legs in front of him. She would complain about allodynia in her legs (and all over) but somehow she was tolerating sitting in that position. Any touch to her legs would get screams, but she could have her legs on top of each other.
She wore a variety of clothing, shorts, pants, leggings. Same kind of thing. She couldn’t tolerate me trying to help her do a leg kick, insisted that anything touching her hurt. But she wore these tight leggings with no issue (I would be tearing the leggings of within 3 seconds if not less)
He never gave up on Maya. My goal was to help her get better. Wanted her to leave the hospital walking, get back to school, that is what we all enjoy. We get into this profession for that very reason, to se them go back to participating in normal activities is why we do what we do.
At the very end he noted that she displays functional strength to complete tasks, but when asked to do things she actively acts with impaired function. (I hate when the camera goes to Mr K. I originally thought he was just a quiet, bulldozed by mom, nice man. He’s an asshole. She tries to intimidate female witnesses by staring them down. This witness is a man, and he smirks at the male witnesses. He sits right next to the jury box)
Judge is apparently not going to allow him to explain his notation. That notation seems to imply that by the time of her release he was convinced that her physical disabilities were at least partially purposeful)
Plaintiff
His recollection was the initial diagnosis in her chart was CRPS, and he was not using confirmation bias on his work with her
I don’t recall seeing conversion disorder in her file.
At the beginning she was willing to attempt therapy. She never declined a therapy session due to “pain”. Whenever she declined a session it was because she was convinced she had a condition for which ketamine was the only effective treatment. She only mentioned pain after agreeing to a session and then saying she can’t do certain movements because of pain. When distracted with an activity that used the same movement, she could attempt it without complaining of pain. Her pain was distractibale.
My recollection the diagnosis was CRPS and I had no other information other than that. My impressions of her were based on my personal interactions with her.
He’s challenging the PT to produce photos of her doing things that she claimed not be be able to do things. He says he has his records that clearly indicate complete with details the specific things that he attempted to do that she said she couldn’t do, and then observations of her doing those things while playing or while in her room, or even while in the PT room while she was not aware that the activity they were doing was using those same muscles or strengths.
Did you get the same memo the last witness did? I don’t know.
Yesterday I got an outline of topics I might be asked. They asked me to look through my records to refresh my recollection of working with Maya. My records were written at the time, I didn’t just write them yesterday.
He was never asked to look for signs of conversion disorder. At the bottom of his note dated 1/6 he had noted that he was informed of an additional diagnosis, and he noted it in his record. He says that his treatment of patients are determined by medical diagnosis and if the medical diagnosis changes, he needs to know about it and he notes it.
Maya’s main complaint was global pain. We got her out of the wheelchair quite a bit during therapy. With assistance, yes. Video of PT in her room. He brings over a walker, Tells her to try to keep her feet flat on the ground. She whimpers while shuffling. She only takes a couple of mini steps and they help her to a chair. He encourages her and tells her that is an improvement since the last time and he’s proud of her. At this point in time she required a significant amount of help to transfer from bed to chair or from any other surface. (he never said she made progress in her legs
Asking if he knows Rachel Dionne at Agility Fitness – he says no. He agrees they never were able to get her to do anything with her legs.
Maya would exhibit spasms in her thighs – I don’t recall seeing spasms in her thighs. Bringing up a note. He explains that she had quad spasms in her legs when he passively moved her legs, which means she was not helping. He lifted them up to work on a range of motion and also put them back. She was not using any muscles at the time, he was doing all the work of moving her legs. Quads are muscles in the top of the legs.
In this instance it’s true that her large muscles had spasms when he moved them for her. (His demeanor was very shaken right from the beginning of Anderson’s questioning, which makes him look less confident. Anderson is good at intimidating witnesses)
Spasms can be indicative of many things. If your legs are very weak, which we know Maya’s legs were extremely weak, they will easily spasm on an attempt to use them. Quad spasms are involuntary. (I see where he’s going. He is stuck on accusing the hospital of claiming that Maya “can walk”. Nobody at the hospital ever said that. What they have consistently said is that she claimed to not be able to do things that they were able to observe her doing when she wasn’t thinking about it or knowing she was being observed)
This is a passive movement so she was not activating any of these muscles herself. She complained of pain and this was the only time he ever saw spasms in her legs. That was why it was notable.
He disagrees that Maya ws not doing well at all at the end.
He says again that many things did improve. They did not get her walking again. The treatment diagnosis was the same, we were still addressing all these things, but that does no mean that she didn’t make the gains that we noted. She was willing to try whatever she was agreeable to. Every session there were things she would not agree to do, so we worked on the things she agreed to work on. It wasn’t always pain that she used for her reason for not working on things. She often said that she did not believe PT was what she needed, she only wanted the ketamine. (I bet she did, no argument there)
She would not push herself past the point where she was comfortable with. I can’t say what she was thinking. Calls for speculation. This is the one where she is trying to slap her legs to move them. She is pounding them with her fist and trying to pull and push her legs with her arms. She’s making a huge drama about it. Giddyup horsey she keeps repeating. Her mother is in the room.
He agrees that she appears to be trying. (YMMV) He explains the foot thingys are to prevent foot drag. The jury has seen multiple photos of her feet in dystonic position. He says when her feet are hanging in the down position that is called foot drop and it’s caused by muscle weakness in the front of the leg. Dystonia is something else and he never say that the whole time Maya was in the hospital. He says dystonia has to do with the calf muscles interacting with nerves where the foot is maintained in a fixed position. That is not what he saw with Maya.
Why is it that every other therapist saw Maya with dystonia both before and after ACH? Objection sustained.
LOL Attorney just said that other therapist did see CONVERSION and everyone saw CONVERSION. Freudian slip maybe?
He says Maya’s feet were always in the down relaxed position and whenever her feet touched the ground the ankles were always flexible and her feet would end up flat on the ground. (You can see that in the video of her playing the piano even)
Dystonia means your feet are locked, very little can be done to move them. Even maximal force would no move the feet into a different position if it was dystonia.
I am not saying she was “trying” to keep her feet inthat position. Her foot position is normal for all of us.
I personally do not recall looking for signs of paralysis. My job as a PT is to find ways to help the patient regain physical function. Weakness, decreased range of motion, things like that. I do not make a medical diagnosis in my job.
My experience with CRPS is that paralysis is not a symptom I have ever seen. When asked to do a leg kick she would say she can’t. I never disbelieved her claims of pain. I take those at face value.
By the time she left she had to slump over in her wheelchair? No, she had achieved core strength and was sitting up by that time.
He’s going to show a photo of her slumping I guess on 1/4/2017. It does say Maya said she couldn’t sit up on that say and she slumped over while getting into the wheelchair. But that was not her usual state by that date in time. She was consistently sitting up
He repeats the improvements. 3 main areas – sitting balance, sit independently, this was consistent by the time of the end. Her posture was more upright with no assistance and no claims of pain while doing an activity while sitting up. Activity tolerance. She went from 2 minutes of sitting with extensive help. At the end she was playing games for more than an hour at a time, and she would be able to sit in various positions. We wished that we could have helped to her to walk again, I was disappointed that didn’t happen, but we did our best to help Maya regain as much functionality as possible
Muscle spasm – you also said spasm can be a sign of weakness, can you explain that? If a patient is in a wheelchair since July 4, 2015 could they have the kind of weakness that cause cause spasms. Yes, he explains that once a leg hasn’t moved in a long time you often see this.
Final PT note – 1/4/2017 – Under other assessment and goals. She displays the functional strength to complete tasks but when specifically asked to complete activities she actively presents with impaired function. (This is the one the judge would not allow him to expand on earlier, maybe a door was opened)
What does this mean? Functional strength means enough strength to perform activities. Throughout all these notes, it’s been noted that she has the strength to hold herself up, reach, do all kinds of things. She could bend all the way forward to pick something up off the ground without any assistance. So, he ahs the strength in her mscles to do all these things. Her core, arms, especially. And when distracted, she does them. She even moves her legs to reposition herself. But when asked to do something, she actively presents with impaired function. That was a very consistent inconsistency we found throughout her time with us.
He doesn’t recall when his very last note was.
Exhibit 1/11/2017 – Do you agree she was doing decreased level of activity. Are you noting decrease activity. No, I am noting a decrease in her participation and attempt to do things. Not a decrease in functionality.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Defense Witness – Jason Banker – Executive Director of Revenue (?) at ACH
MBA, Leadership , good credentials
Healthcare finance his entire career, he’s in his 50’s approx.
When patient comes in he’s part of the registration process, all services are captured, makes sure a clean bill goes out the door, addresses concerns or patient balances.
Met last night (he is a witness that was asked to be on standby because of plaintiff whining)
Had a chance to review billing for Maya’s stay at the hospital. Aetna insurance was billed
He reviewed all billing and all communications for procedures performed and billing atht took place.
Plaintiff wants sidebar, it last about two seconds
In his role he interfaces with insurance companies all the time
For a lot of inpaiient stays there is constant feedback and communication with case management. There were 14 correspondences regarding medical documentation to ensure medical necessity.
Medical necessity means that any care that is provided is actually needed. If thee is a lung transplant for someone who comes in for a cough, insurance company is going to balk
What would happen if the hospital was billing for services that were not being rendered what would happen? The claim would be denied. Two types of denial. Aetna never denied any claim based on medical necessity or for no authorization. Those are two key denials that would typically have taken place in any situation where claims were denied.
Exhibit – says this exhibit is not a bill. This looks like something internal to Aetna within their own system, but this is not a bill from JHACH
He has a great deal of experience with this type of paperwork. He stresses that this is not a bill.
(Sidebar – Jury is being removed from courtroom The plaintiff had originally wanted a proffer and the judge appeared to be trying hard not to roll his eyes. Mr Anderson is a great waster of time and the judge really seems to be on his last leg with this kind of thing)
Now, apparently we are going to have a proffer:
1. Does this exhibit appear to be a document from Aetna that indicates a diagnosis code that is in line with what you have seen on the bills that were submitted for Maya K during her stay? Yes
2. In your training and experience do you have sufficient knowledge and experience to look at a diagnosis code and be able to educate the jury on how that would relate to an actual bill that would be submitted from ACH to Aetna? Yes
3. Are you aware whether these are the codes that ACH submitted when they submitted bills? I have seem many of these same codes based on the billing that I reviewed
4. Are you able to explain to the jury about how these codes all relate together on a billing by ACH? Yes
5. And would you be able to educate the jury on how the diagnostic related group codes when combined would create a medical charge (Mr K is suing the hospital for a myriad of claims including billing fraud.)
6. Do you have sufficient training and experience to be able to give those explanations to the jury? Yes
Plaintiff (Mr Whitney)
1. By way of background you have an MBA? Yes
2. How long after did you join ACH? 1 year after MBA, I was in health care finance for 22 years prior to getting my MBA
3. Who did you work for? Geisner Health System for 15 years, Penn State Health for 3 years, Title Health for 3 years, ACH for 1 year
4. Geisner Health is a massive health system – 6 billion dollars in annual health revenue. Director of Revenue Cycle Integrity for a period of time, that dealt with coding issues, billing issues, CDM issues, charge capture issues, things of that nature
5. Judge asks about Revenue Inegrity – he explains it has to do with ensuring the accuracy of claims. (this goes directly to the issue hwere)
6. Billing from the provider side to the insurance company
7. Penn State – his role was Director over the entire revenue cycle, not just one piece of it.
8. Also oversaw the entire revenue cycle of all acquisitions (sound slike they bought up a whole shitload of hospitals)
9. Transitioned into overseeing the entire billing and collections systems for all hospitals in the group
10. Many communications with insurance companies and familiarity with their paperwork and codding
11. Title Health – similar to previous two. Very similar to ACH
12. ACH – similar
13. You’ve never worked for Aetna? True
14. Never created a document like the exhibit - It’s an Aetna record, generated by Aetna. He doesn’t create these himself. He doesn’t agree that he doesn’t understand where their information comes from. He can directly relate this document back to a bill generated by ACH
15. You can’t tell us what this specific number means on this page? I see the diagnostic codes. What I can tell you is that WE supply these codes to them, they don’t magically appear, we provide this information to them. They create their own documents and reports
16. Not a certified professional coder
17. It’s not just coding. It’s scheduling, overseeing the coding team, ensuring the services provided are coded properly, submitting to insurance company and receiving payment. The revenue cycle encompasses everything.
18. I can look at this paper and see that this specific code related to a diagnosis of CRPS
19. ACH has an entire set of bills that were submitted on behalf of the Kowolski family to Aetna? Yes, we submitted both hospital and professional services billing to Aetna
20. I did not bring every bill with me hee today
21. This exhibit is an incomplete story, I would not be able to explain this exhibit without seeing the corresponding billing from our side.
Defense
1. Put back exhibit – In my role it is not unusual for me to review a document such as this exhibit and compare with our billing to clear up any issues if the insurance company is sending us this document because of an issue.
2. Is this true of other insurance companies? Yes, we have consistent communication with all of our payors
Approach bench –
This witness has been called by the defense to refute that ACH billed 500K for CRPS, which they did not. They only thing they are disputing is if he can look at Aetna’s internal reporting that have numbers that came from ACH. ( this is what pains me about the plaintiff – they take things that they know are false and make a red herring of it). They want to use Aetna documents to dispute how much ACH billed under certain diagnosis codes. But we have actual ACH billing which clearly shows what was billed. These were paid with no copays, the K family did not pay one cent for Maya’s entire stay in the hospital. The billing contained all of the various diagnosis codes from all of the differential diagnoses. They wanted Mr K to get on the stand and interpret Aetna’s paperwork and this witness has vastly more experience in understanding insurance company paperwork. He testified that in the event the insurance company has any dispute, this is exactly the paperwork they would send to him in order for him to research.
Every Aetna document
(it has to be said here that it ws the family itself that stood in the way of Maya getting a final, absolute diagnosis because they refused permission for various tests.)
Plaintiff
He has no foundational knowledge to talk about how the bills from Aetna are created ( The K family never received one goddam bill). How that information is coalesced and how it comes to appear on this printed paperwork. He’s not a certified coder. And that is where this is going to go. He is going to try to
It sounds like without having an expert coder that we cannot have any witness present about billing. We move for a directed verdict because plaintiff is the one suing for billing fraud, they claim the only valid witness would be a certified medical coder and they have never called one as a witness and when creating a situation where we had to bring in a “billing expert” which is what they asked for they never said that person had to be a certified medical coder. They never put medical bills in evidence and now they are trying to prevent the defense from bringing in a witness to talk about how billing is generated and we have an expert, he does this all day every day, they want to say he’s not qualified.
Judge says it seems to me there was an agreement between the parties about the medical bill issue. I don’t remember the exact contours of the agreement. I do remember there was a specific issue. What it seems Mr Whitney you are attempting to have me say that this witness can’t testify to something that people he supervises deal with on a day in day out basis. He is over the entire billing system, including medical coders. It seems to me that yes, he’s commenting on an Aetna document, but you have the same ability to cross reference it back to a medical bill, which I suspect is very easy to do. If the whole issue is to get the truth to the jury and both hospital bill and Aena bill matches. Maybe you will come up with an explosive cross exam, I don’t know. (they didn’t)
Bring in the witness, bring in the jury
Defense resumes
I’m too tired to write detaila.
The gist of it is that the Plaintiff has brought Aetna insurance “reports” that the plaintiff requested Aetna to provide to them. Those reports are not hospital bills, the are reports from Aetna’s reporting system.
Mr K is accusing the hospital of fraudulent billing based on “they didn’t believe Maya had CRPS but ere billing for CRPS”
The witness explains we bill for services rendered. The paperwork filled out by physicians, PT, OT, Psych and other providers indicates the services they provided, i.e. physical therapy, specific drug dispensed, room and board, food, etc. For each diagnosis that is carried on her record when a bill for services is produced, the system will indicate which diagnosis on record is authorized to have that service. The board certified medical coders are the ones who assign diagnosis codes to each service rendered. CRPS was carried on her medical record for the entire time she was in the hospital largely due to the parent’s denial for her to have testing to adequately rule in and possibly completely rule out CRPS. That was only one of twelve differential diagnosis on her chart and the insurance company only one time questioned a single charge of $11.95. The hospital agreed to just drop that charge, so the K family did not have to pay the $12.00 themselves, it wasn’t worth the hospital time to use a certified coder’s hour of time to run that down. So they just dropped it.
According to Aetnas records, The K family did not pay one single cent for the entire 3 months that Maya was occupying a room and using PT resources (and not even trying to get better, so essentially wasting their time)
I am not sure how this count ever survived a directed verdict because the K family did not have to pay anything at all, so 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. They had exhausted all of their copays for the year long before October, so they didn’t even have a copay for anything. Her total billing for that 3 months of care was over 500K and qualified for “agreed upon rates” to kick in so even Aetna didn’t pay the hospital but a for a fraction of the value of services that Maya consumed during that stay.
MBA, Leadership , good credentials
Healthcare finance his entire career, he’s in his 50’s approx.
When patient comes in he’s part of the registration process, all services are captured, makes sure a clean bill goes out the door, addresses concerns or patient balances.
Met last night (he is a witness that was asked to be on standby because of plaintiff whining)
Had a chance to review billing for Maya’s stay at the hospital. Aetna insurance was billed
He reviewed all billing and all communications for procedures performed and billing atht took place.
Plaintiff wants sidebar, it last about two seconds
In his role he interfaces with insurance companies all the time
For a lot of inpaiient stays there is constant feedback and communication with case management. There were 14 correspondences regarding medical documentation to ensure medical necessity.
Medical necessity means that any care that is provided is actually needed. If thee is a lung transplant for someone who comes in for a cough, insurance company is going to balk
What would happen if the hospital was billing for services that were not being rendered what would happen? The claim would be denied. Two types of denial. Aetna never denied any claim based on medical necessity or for no authorization. Those are two key denials that would typically have taken place in any situation where claims were denied.
Exhibit – says this exhibit is not a bill. This looks like something internal to Aetna within their own system, but this is not a bill from JHACH
He has a great deal of experience with this type of paperwork. He stresses that this is not a bill.
(Sidebar – Jury is being removed from courtroom The plaintiff had originally wanted a proffer and the judge appeared to be trying hard not to roll his eyes. Mr Anderson is a great waster of time and the judge really seems to be on his last leg with this kind of thing)
Now, apparently we are going to have a proffer:
1. Does this exhibit appear to be a document from Aetna that indicates a diagnosis code that is in line with what you have seen on the bills that were submitted for Maya K during her stay? Yes
2. In your training and experience do you have sufficient knowledge and experience to look at a diagnosis code and be able to educate the jury on how that would relate to an actual bill that would be submitted from ACH to Aetna? Yes
3. Are you aware whether these are the codes that ACH submitted when they submitted bills? I have seem many of these same codes based on the billing that I reviewed
4. Are you able to explain to the jury about how these codes all relate together on a billing by ACH? Yes
5. And would you be able to educate the jury on how the diagnostic related group codes when combined would create a medical charge (Mr K is suing the hospital for a myriad of claims including billing fraud.)
6. Do you have sufficient training and experience to be able to give those explanations to the jury? Yes
Plaintiff (Mr Whitney)
1. By way of background you have an MBA? Yes
2. How long after did you join ACH? 1 year after MBA, I was in health care finance for 22 years prior to getting my MBA
3. Who did you work for? Geisner Health System for 15 years, Penn State Health for 3 years, Title Health for 3 years, ACH for 1 year
4. Geisner Health is a massive health system – 6 billion dollars in annual health revenue. Director of Revenue Cycle Integrity for a period of time, that dealt with coding issues, billing issues, CDM issues, charge capture issues, things of that nature
5. Judge asks about Revenue Inegrity – he explains it has to do with ensuring the accuracy of claims. (this goes directly to the issue hwere)
6. Billing from the provider side to the insurance company
7. Penn State – his role was Director over the entire revenue cycle, not just one piece of it.
8. Also oversaw the entire revenue cycle of all acquisitions (sound slike they bought up a whole shitload of hospitals)
9. Transitioned into overseeing the entire billing and collections systems for all hospitals in the group
10. Many communications with insurance companies and familiarity with their paperwork and codding
11. Title Health – similar to previous two. Very similar to ACH
12. ACH – similar
13. You’ve never worked for Aetna? True
14. Never created a document like the exhibit - It’s an Aetna record, generated by Aetna. He doesn’t create these himself. He doesn’t agree that he doesn’t understand where their information comes from. He can directly relate this document back to a bill generated by ACH
15. You can’t tell us what this specific number means on this page? I see the diagnostic codes. What I can tell you is that WE supply these codes to them, they don’t magically appear, we provide this information to them. They create their own documents and reports
16. Not a certified professional coder
17. It’s not just coding. It’s scheduling, overseeing the coding team, ensuring the services provided are coded properly, submitting to insurance company and receiving payment. The revenue cycle encompasses everything.
18. I can look at this paper and see that this specific code related to a diagnosis of CRPS
19. ACH has an entire set of bills that were submitted on behalf of the Kowolski family to Aetna? Yes, we submitted both hospital and professional services billing to Aetna
20. I did not bring every bill with me hee today
21. This exhibit is an incomplete story, I would not be able to explain this exhibit without seeing the corresponding billing from our side.
Defense
1. Put back exhibit – In my role it is not unusual for me to review a document such as this exhibit and compare with our billing to clear up any issues if the insurance company is sending us this document because of an issue.
2. Is this true of other insurance companies? Yes, we have consistent communication with all of our payors
Approach bench –
This witness has been called by the defense to refute that ACH billed 500K for CRPS, which they did not. They only thing they are disputing is if he can look at Aetna’s internal reporting that have numbers that came from ACH. ( this is what pains me about the plaintiff – they take things that they know are false and make a red herring of it). They want to use Aetna documents to dispute how much ACH billed under certain diagnosis codes. But we have actual ACH billing which clearly shows what was billed. These were paid with no copays, the K family did not pay one cent for Maya’s entire stay in the hospital. The billing contained all of the various diagnosis codes from all of the differential diagnoses. They wanted Mr K to get on the stand and interpret Aetna’s paperwork and this witness has vastly more experience in understanding insurance company paperwork. He testified that in the event the insurance company has any dispute, this is exactly the paperwork they would send to him in order for him to research.
Every Aetna document
(it has to be said here that it ws the family itself that stood in the way of Maya getting a final, absolute diagnosis because they refused permission for various tests.)
Plaintiff
He has no foundational knowledge to talk about how the bills from Aetna are created ( The K family never received one goddam bill). How that information is coalesced and how it comes to appear on this printed paperwork. He’s not a certified coder. And that is where this is going to go. He is going to try to
It sounds like without having an expert coder that we cannot have any witness present about billing. We move for a directed verdict because plaintiff is the one suing for billing fraud, they claim the only valid witness would be a certified medical coder and they have never called one as a witness and when creating a situation where we had to bring in a “billing expert” which is what they asked for they never said that person had to be a certified medical coder. They never put medical bills in evidence and now they are trying to prevent the defense from bringing in a witness to talk about how billing is generated and we have an expert, he does this all day every day, they want to say he’s not qualified.
Judge says it seems to me there was an agreement between the parties about the medical bill issue. I don’t remember the exact contours of the agreement. I do remember there was a specific issue. What it seems Mr Whitney you are attempting to have me say that this witness can’t testify to something that people he supervises deal with on a day in day out basis. He is over the entire billing system, including medical coders. It seems to me that yes, he’s commenting on an Aetna document, but you have the same ability to cross reference it back to a medical bill, which I suspect is very easy to do. If the whole issue is to get the truth to the jury and both hospital bill and Aena bill matches. Maybe you will come up with an explosive cross exam, I don’t know. (they didn’t)
Bring in the witness, bring in the jury
Defense resumes
I’m too tired to write detaila.
The gist of it is that the Plaintiff has brought Aetna insurance “reports” that the plaintiff requested Aetna to provide to them. Those reports are not hospital bills, the are reports from Aetna’s reporting system.
Mr K is accusing the hospital of fraudulent billing based on “they didn’t believe Maya had CRPS but ere billing for CRPS”
The witness explains we bill for services rendered. The paperwork filled out by physicians, PT, OT, Psych and other providers indicates the services they provided, i.e. physical therapy, specific drug dispensed, room and board, food, etc. For each diagnosis that is carried on her record when a bill for services is produced, the system will indicate which diagnosis on record is authorized to have that service. The board certified medical coders are the ones who assign diagnosis codes to each service rendered. CRPS was carried on her medical record for the entire time she was in the hospital largely due to the parent’s denial for her to have testing to adequately rule in and possibly completely rule out CRPS. That was only one of twelve differential diagnosis on her chart and the insurance company only one time questioned a single charge of $11.95. The hospital agreed to just drop that charge, so the K family did not have to pay the $12.00 themselves, it wasn’t worth the hospital time to use a certified coder’s hour of time to run that down. So they just dropped it.
According to Aetnas records, The K family did not pay one single cent for the entire 3 months that Maya was occupying a room and using PT resources (and not even trying to get better, so essentially wasting their time)
I am not sure how this count ever survived a directed verdict because the K family did not have to pay anything at all, so 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. They had exhausted all of their copays for the year long before October, so they didn’t even have a copay for anything. Her total billing for that 3 months of care was over 500K and qualified for “agreed upon rates” to kick in so even Aetna didn’t pay the hospital but a for a fraction of the value of services that Maya consumed during that stay.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
My sister got curious about this case and wanted to watch the Netflix special. So we watched it together. It was very interesting watching it a second time, this time after having the benefit of hearing most of the testimony (testimony is supposed to end on Wednesday).
When I watched the Netflix hospital hit piece the first time it took me no time at all to come to the conclusion that she doesn't have CRPS. And there were other things in that special that I suspected. It was clearly one sided, they provided scant information from any doctor's point of view.
I remember when Dr Mendez was testifying, at one point the defense asked if he had recorded, audio or video or both, any of the visit. His response was no. He was asked if he was aware that Beata had recorded both audio and video and he responded "no". I understand now why they asked this question. The jury is getting lots of exhibits including a great deal of video from Beata's phone (she had surreptitiously recorded both of the visits with him and probably other doctors as well). The Netflix special contains two small excerpts from both of those visits to Dr Mendez. She apparently propped her phone beside her purse or against something and the audio is clear, but the video shows basically just the doctor's legs, Beata's legs for the first visit. The second visit to Mendez you can see Maya, who looks really happy until the doctor starts saying he isn't seeing anything to indicate immune deficiency, Maya starts whimpering and the video cuts off. In testimony he describes that Maya started whimpering at first and then screaming and hollering that she was in pain after he continued to indicate that there is no immune deficiency indicated in any of the extensive lab testing that he ordered. These excerpts I am describing are in the Netflix special, but I think the jury is going to see the whole thing for both of them.
What else is interesting in the Netflix video is how Jack just flat out lies throughout that special. I had not really known that much of what he says in this special is a flat out lie the first time I watched it. But now that I've seen the actual testimony, and saw it again, I was pausing that special constantly and telling my sister what he just said is a flat out lie and even contradicted by his own admissions on the witness stand and his own interview from the law enforcement investigator.
It's sickening to me how many people watched that special and absolutely believe it's a true representation of the events surrounding this girl's medical history and treatment. It's pure fiction. I questioned quite a bit of it just because I happen to have CRPS. But, I had not realized on my first viewing of it that beyond the things I questioned, that whole documentary is pure propaganda. Very little of what is in there is true. I think there may have been one or two sentences in that whole special that I actually told my sister, "well, that is one thing that is actually true".
And it features a reporter that says that in all of Pinellas County, every medical child abuse case in a long time period has Dr Sally Smith and JHACH all over it. Well, actually, yes. That is true. And that is because Dr Sally Smith was the ONLY Medical Director for Pinellas County Child Protection Team and she was required to be the one who gathered all the medical information together and JHACH is the only pediatric hospital in Pinellas County, so that is where any pediatric patient that has any injuries consistent with possible child abuse will be sent. So, if a child is taken to one of the other non pediatric hospitals and presents with suspicious injuries they will send them to JHACH. So, yeah. That makes perfect sense that "Sally Smith and JHACH are all over all the child abuse cases". She was Medical Director from 2002 to June 2023 for Pinellas County.
Another piece of "reporting" from the special is two women and a man who had their kids removed temporarily. The interesting thing are two women, apparently single (they never show a man with either of them) whose kids were briefly removed from their care and the case eventually dropped. One of them were reported because their child 's brain scan showed an old injury consistent with head trauma and then a new injury in a different location of the brain consistent with head trauma. It's a little unusual for a child to ever have any injury consistent with head trauma, much less two head traumas in the space of a year. I would be willing to bet there's probably something like, say, a boyfriend, who maybe did something, and maybe because the mother wouldn't kick the boyfriend out of her house that is WHY her child was taken away. And maybe she ended up finally ridding herself of said boyfriend, and maybe that's why the case was dropped and she got her child back. The point is that the special just presents her telling of her child being removed temporarily and eventually she gets him back. No other details. And at one point they show a photo of her, the boy, and a grown man. And then they show her and a different man putting decorations on a Christmas tree. Different man than the photo. Maybe there's a little detail there that is missing from the story.
Pure fiction and propaganda. I don't know if one can enter a review for these, but I am tempted to do that.
When I watched the Netflix hospital hit piece the first time it took me no time at all to come to the conclusion that she doesn't have CRPS. And there were other things in that special that I suspected. It was clearly one sided, they provided scant information from any doctor's point of view.
I remember when Dr Mendez was testifying, at one point the defense asked if he had recorded, audio or video or both, any of the visit. His response was no. He was asked if he was aware that Beata had recorded both audio and video and he responded "no". I understand now why they asked this question. The jury is getting lots of exhibits including a great deal of video from Beata's phone (she had surreptitiously recorded both of the visits with him and probably other doctors as well). The Netflix special contains two small excerpts from both of those visits to Dr Mendez. She apparently propped her phone beside her purse or against something and the audio is clear, but the video shows basically just the doctor's legs, Beata's legs for the first visit. The second visit to Mendez you can see Maya, who looks really happy until the doctor starts saying he isn't seeing anything to indicate immune deficiency, Maya starts whimpering and the video cuts off. In testimony he describes that Maya started whimpering at first and then screaming and hollering that she was in pain after he continued to indicate that there is no immune deficiency indicated in any of the extensive lab testing that he ordered. These excerpts I am describing are in the Netflix special, but I think the jury is going to see the whole thing for both of them.
What else is interesting in the Netflix video is how Jack just flat out lies throughout that special. I had not really known that much of what he says in this special is a flat out lie the first time I watched it. But now that I've seen the actual testimony, and saw it again, I was pausing that special constantly and telling my sister what he just said is a flat out lie and even contradicted by his own admissions on the witness stand and his own interview from the law enforcement investigator.
It's sickening to me how many people watched that special and absolutely believe it's a true representation of the events surrounding this girl's medical history and treatment. It's pure fiction. I questioned quite a bit of it just because I happen to have CRPS. But, I had not realized on my first viewing of it that beyond the things I questioned, that whole documentary is pure propaganda. Very little of what is in there is true. I think there may have been one or two sentences in that whole special that I actually told my sister, "well, that is one thing that is actually true".
And it features a reporter that says that in all of Pinellas County, every medical child abuse case in a long time period has Dr Sally Smith and JHACH all over it. Well, actually, yes. That is true. And that is because Dr Sally Smith was the ONLY Medical Director for Pinellas County Child Protection Team and she was required to be the one who gathered all the medical information together and JHACH is the only pediatric hospital in Pinellas County, so that is where any pediatric patient that has any injuries consistent with possible child abuse will be sent. So, if a child is taken to one of the other non pediatric hospitals and presents with suspicious injuries they will send them to JHACH. So, yeah. That makes perfect sense that "Sally Smith and JHACH are all over all the child abuse cases". She was Medical Director from 2002 to June 2023 for Pinellas County.
Another piece of "reporting" from the special is two women and a man who had their kids removed temporarily. The interesting thing are two women, apparently single (they never show a man with either of them) whose kids were briefly removed from their care and the case eventually dropped. One of them were reported because their child 's brain scan showed an old injury consistent with head trauma and then a new injury in a different location of the brain consistent with head trauma. It's a little unusual for a child to ever have any injury consistent with head trauma, much less two head traumas in the space of a year. I would be willing to bet there's probably something like, say, a boyfriend, who maybe did something, and maybe because the mother wouldn't kick the boyfriend out of her house that is WHY her child was taken away. And maybe she ended up finally ridding herself of said boyfriend, and maybe that's why the case was dropped and she got her child back. The point is that the special just presents her telling of her child being removed temporarily and eventually she gets him back. No other details. And at one point they show a photo of her, the boy, and a grown man. And then they show her and a different man putting decorations on a Christmas tree. Different man than the photo. Maybe there's a little detail there that is missing from the story.
Pure fiction and propaganda. I don't know if one can enter a review for these, but I am tempted to do that.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
Judge is reading the dependency court dates with order details to the jury. All of the counts have date issues because the hospital had no control over certain things during specified date ranges. So, the jury had to be aware of the various dates. They will have this information available in the packet of information they will be taking with them to the jury room
Dates and restrictions are important
1. The court has previously determined that ACH had cause to initiate a call to Florida’s child abuse hotline, therefore ACH is immune from any claim that might otherwise result by reporting the suspected abuse
2. Having said that, ACH does not have immunity for any of the claims being presented to you as a jury
3. Prior to Oct 14, 2016, there was no dependency court order governing Maya’s stay at ACH
4. From Oct 14, 2016 to Jan 6, 2017 Maya K could not be discharged from ACH without express permission from the court
5. The fact that she was kept in the hospital and the fact that Beata K could not visit Maya are not matters for which ACH is responsible under any of the claims included
6. The dependency court placed Maya in the shelter of DCF on their first order on Oct 14
7. Although this status limited some of the parent’s rights, it did not limit their rights to be informed of Maya’s treatment and to participate in decisions concerning her treatment
8. The court will now inform you of the relevant terms of the fie dependency court orders
1st Order - Effective 2:30 AM on Oct 13, 2016 As to Beata K- prohibited any contact with Maya by any means including in person, phone, text, online, or any other means. As to Jack and Kyle – required any visit be supervised by an adult approved by DCF. Kyle K was permitted to visit if Jack was present as well. There was no time limit placed on these visits (Jack testified he was limited, but nobody else agreed that he had ever been asked to leave at any time, he had to sign in and out, so I’m assuming the jury will have those records, sign in/sign out, available to them). DCF, not ACH, was required to make every effort to identify and select a supervisor to assist and supervise these visits. DCF was required to provide such supervision in all cases it files, it did not create special rules in providing rules for supervision.
The first order did not prevent ACH from applying it’s own rules regarding visitation and communications with other patients unless these rules conflicted with the stricter rules provided in the court order. That is to say the hospital could not use it’s own rules to override any stricter rules in the court order.
2nd order – Nov 10, 2016 – The second order changed the terms regarding contact on a going forward basis. Beata K – Allowed her to have supervised phone calls with Maya K. The court directed that either the guardian ad litem or the case manager to supervise these calls. The calls were to be at a time convenient to ACH, as well as the guardian ad litem or case manager at DCF. The court did not provide that ACH could supervise the calls. It also allowed Beata to have contact through written correspondence. A designee from the Safe Children’s Coalition was required to review the materials and promptly forward them to Beata or Maya. Any material that was deemed to be inappropriate could be withheld, but the designee was to notify the lawyers in the dependency action as to the reason the materials were deemed to be inappropriate. ACH had no role in this process.
Jack and Kyle – Nov 10 order allowed unsupervised contact between Jack and Kyle and Maya. Mr K and Kyle did have to abide by ACH rules, visiting hours. Maya’s treatment needs were to b given priority and ACH was encouraged to allow as much contact as possible provided it did not interfere with Maya’s care. Mr K and Kyle were prohibited from discussing her pain, It’s causes, the allegations against her parents, or when and how the dependency action would be resolved. Mr K and Kyle were required to be positive about her rehabilitation efforts and progress, and to follow the recommendation of ACH treatment staff as to how to interact with Maya. The number of visitors and the time of visits required to be arranged in advance so no unannounced visits were permitted.
Friends and other family – allowed Maya and Jack to designate two of Maya’s friends and two other relatives as visitors subject to a background check and clearance by DCF. Once cleared, they were allowed to have unsupervised visits. These visits were subject to the same conditions as Mr K and Kyle’s conditions as specified above
Maya’s attorney – Directed ACH to make necessary arrangements to have in person and secure telephonic communications with Maya.
Other – Allowed Maya to have religious artifacts that did not interfere with her rehabilitation. ACH was encouraged to allow a Catholic Priest to visit Maya.
If any person violated the dependcy court order, or negatively affected Maya’s rehabilitation, ACH was authorized to suspend that person’s contact with Maya.
3rd order Dec 9, 2016 – Special order to address Maya’s birthday. It allowed Mr K and Maya’s uncle to visit ACH in accordance with ACH visitation policies. The visit would only be permitted if it would not adversely affect Maya or impede rehabilitation efforts.
4th order – Dec 16, 2016 – Changed some, but not all, terms. Beata K – permitted video contact via Skype/Facetime or other electronic means at times approved by ACH. Allowed ACH to supervise these calls. The medical staff could suspend these calls. This was a change from Nov 10 order. Despite this change to video calls, the Dec 16 order did not change the Nov 10 order’s requirements regarding written materials.
Mr K and Kyle – nothing changed since Nov 10 order
Mark Zimmerman (Maya’s new attorney) – With reasonable notice to ACH she could have secure communication with this attorney. This alters the identity of Maya’s attorney from the previous attorney and slightly altered the oblication on ACH
Other – did not change Nov 10 order regarding other relevant requirements
5th order – Dec 27, 2016 – Substantially changed contact with Maya on a going forward basis. Beata – allowed daily video calls at approx. 11 AM and 5 PM daily. Permitted but did not require the guardian ad litem, case manager, or any employee of ACH staff to supervise the calls. Beata was not permitted to make any disparaging comments. ACH was allowed to suspend the video call if Beata violated the court order, violated ACH policy, or acted to negatively affect Maya’s rehabilitation.
Jack K, Kyle K, Aunt, Uncle – Allowed each to have unsupervised unlimited visits with Maya. Required to announce the visit at least 2 hours in advance. Visitors must abide by ACH visitation policy. Not allowed to make any disparaging comments. ACH was allowed to suspend any visit if that person violdated any of these rules.
Other – prevented any other person aside from the 5 family members from communicating with Maya.
Jan 13, 2017 – Discharging Maya from the hospital to her father’s custody. At that time visitation orders ceased.
(The court required Mr K to pursue appropriate treatment for Maya (no ketamine or opioid medications allowed , she had been completely weaned off them by this time. I don’t think she ever got the appropriate amount of psychiatric treatment, but she got physical therapy, occupational therapy, pool therapy and by the time school started whe was out of her wheelchair.. But ACH had nothing more to do with Maya after Jan 13, so none of this was mentioned to the jury. )
Mr K was allowed to moan and groan about it being the hospital’s fault that he had to comply with their recommended treatment after her release. The treatment that actually made her better and allowed her to return to normal life within a few months. They claim she got worse during her stay at the hospital, but I don’t know how they are going to get around the fact that she voluntarily filled out the Quality of Life Survey in Oct 2016 as ZERO QOL and was out of her wheelchair by August 2017 after following the treatment plan outlined by doctors at JHACH.
Dates and restrictions are important
1. The court has previously determined that ACH had cause to initiate a call to Florida’s child abuse hotline, therefore ACH is immune from any claim that might otherwise result by reporting the suspected abuse
2. Having said that, ACH does not have immunity for any of the claims being presented to you as a jury
3. Prior to Oct 14, 2016, there was no dependency court order governing Maya’s stay at ACH
4. From Oct 14, 2016 to Jan 6, 2017 Maya K could not be discharged from ACH without express permission from the court
5. The fact that she was kept in the hospital and the fact that Beata K could not visit Maya are not matters for which ACH is responsible under any of the claims included
6. The dependency court placed Maya in the shelter of DCF on their first order on Oct 14
7. Although this status limited some of the parent’s rights, it did not limit their rights to be informed of Maya’s treatment and to participate in decisions concerning her treatment
8. The court will now inform you of the relevant terms of the fie dependency court orders
1st Order - Effective 2:30 AM on Oct 13, 2016 As to Beata K- prohibited any contact with Maya by any means including in person, phone, text, online, or any other means. As to Jack and Kyle – required any visit be supervised by an adult approved by DCF. Kyle K was permitted to visit if Jack was present as well. There was no time limit placed on these visits (Jack testified he was limited, but nobody else agreed that he had ever been asked to leave at any time, he had to sign in and out, so I’m assuming the jury will have those records, sign in/sign out, available to them). DCF, not ACH, was required to make every effort to identify and select a supervisor to assist and supervise these visits. DCF was required to provide such supervision in all cases it files, it did not create special rules in providing rules for supervision.
The first order did not prevent ACH from applying it’s own rules regarding visitation and communications with other patients unless these rules conflicted with the stricter rules provided in the court order. That is to say the hospital could not use it’s own rules to override any stricter rules in the court order.
2nd order – Nov 10, 2016 – The second order changed the terms regarding contact on a going forward basis. Beata K – Allowed her to have supervised phone calls with Maya K. The court directed that either the guardian ad litem or the case manager to supervise these calls. The calls were to be at a time convenient to ACH, as well as the guardian ad litem or case manager at DCF. The court did not provide that ACH could supervise the calls. It also allowed Beata to have contact through written correspondence. A designee from the Safe Children’s Coalition was required to review the materials and promptly forward them to Beata or Maya. Any material that was deemed to be inappropriate could be withheld, but the designee was to notify the lawyers in the dependency action as to the reason the materials were deemed to be inappropriate. ACH had no role in this process.
Jack and Kyle – Nov 10 order allowed unsupervised contact between Jack and Kyle and Maya. Mr K and Kyle did have to abide by ACH rules, visiting hours. Maya’s treatment needs were to b given priority and ACH was encouraged to allow as much contact as possible provided it did not interfere with Maya’s care. Mr K and Kyle were prohibited from discussing her pain, It’s causes, the allegations against her parents, or when and how the dependency action would be resolved. Mr K and Kyle were required to be positive about her rehabilitation efforts and progress, and to follow the recommendation of ACH treatment staff as to how to interact with Maya. The number of visitors and the time of visits required to be arranged in advance so no unannounced visits were permitted.
Friends and other family – allowed Maya and Jack to designate two of Maya’s friends and two other relatives as visitors subject to a background check and clearance by DCF. Once cleared, they were allowed to have unsupervised visits. These visits were subject to the same conditions as Mr K and Kyle’s conditions as specified above
Maya’s attorney – Directed ACH to make necessary arrangements to have in person and secure telephonic communications with Maya.
Other – Allowed Maya to have religious artifacts that did not interfere with her rehabilitation. ACH was encouraged to allow a Catholic Priest to visit Maya.
If any person violated the dependcy court order, or negatively affected Maya’s rehabilitation, ACH was authorized to suspend that person’s contact with Maya.
3rd order Dec 9, 2016 – Special order to address Maya’s birthday. It allowed Mr K and Maya’s uncle to visit ACH in accordance with ACH visitation policies. The visit would only be permitted if it would not adversely affect Maya or impede rehabilitation efforts.
4th order – Dec 16, 2016 – Changed some, but not all, terms. Beata K – permitted video contact via Skype/Facetime or other electronic means at times approved by ACH. Allowed ACH to supervise these calls. The medical staff could suspend these calls. This was a change from Nov 10 order. Despite this change to video calls, the Dec 16 order did not change the Nov 10 order’s requirements regarding written materials.
Mr K and Kyle – nothing changed since Nov 10 order
Mark Zimmerman (Maya’s new attorney) – With reasonable notice to ACH she could have secure communication with this attorney. This alters the identity of Maya’s attorney from the previous attorney and slightly altered the oblication on ACH
Other – did not change Nov 10 order regarding other relevant requirements
5th order – Dec 27, 2016 – Substantially changed contact with Maya on a going forward basis. Beata – allowed daily video calls at approx. 11 AM and 5 PM daily. Permitted but did not require the guardian ad litem, case manager, or any employee of ACH staff to supervise the calls. Beata was not permitted to make any disparaging comments. ACH was allowed to suspend the video call if Beata violated the court order, violated ACH policy, or acted to negatively affect Maya’s rehabilitation.
Jack K, Kyle K, Aunt, Uncle – Allowed each to have unsupervised unlimited visits with Maya. Required to announce the visit at least 2 hours in advance. Visitors must abide by ACH visitation policy. Not allowed to make any disparaging comments. ACH was allowed to suspend any visit if that person violdated any of these rules.
Other – prevented any other person aside from the 5 family members from communicating with Maya.
Jan 13, 2017 – Discharging Maya from the hospital to her father’s custody. At that time visitation orders ceased.
(The court required Mr K to pursue appropriate treatment for Maya (no ketamine or opioid medications allowed , she had been completely weaned off them by this time. I don’t think she ever got the appropriate amount of psychiatric treatment, but she got physical therapy, occupational therapy, pool therapy and by the time school started whe was out of her wheelchair.. But ACH had nothing more to do with Maya after Jan 13, so none of this was mentioned to the jury. )
Mr K was allowed to moan and groan about it being the hospital’s fault that he had to comply with their recommended treatment after her release. The treatment that actually made her better and allowed her to return to normal life within a few months. They claim she got worse during her stay at the hospital, but I don’t know how they are going to get around the fact that she voluntarily filled out the Quality of Life Survey in Oct 2016 as ZERO QOL and was out of her wheelchair by August 2017 after following the treatment plan outlined by doctors at JHACH.
There's a lot of things that need to change. One specifically? Police brutality.
--Colin Kaepernick
--Colin Kaepernick
Taking Care of Maya - FL CPS/Munchausen case
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 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.
Optimism is a good characteristic, but if carried to an excess, it becomes foolishness.
—Theodore Roosevelt
—Theodore Roosevelt
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Kriselda Gray
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Taking Care of Maya - FL CPS/Munchausen case
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...
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pipistrelle
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Taking Care of Maya - FL CPS/Munchausen 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.Kriselda Gray wrote: ↑Sun Oct 29, 2023 8:50 amThe 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...