Dr Amin Roberts, a paediatric gastroenterologist who diagnosed suspected medical child abuse in a young patient who was referred to him. He gave evidence in the trial underway in the High Court at Nelson, now in its fifth week. Photo \/ Norrie Montgomery <\/p>\n
However, in the case of Child X, he alleged there was no other explanation after lengthy and detailed efforts by a string of medical specialists and nursing staff<\/a> to get to the bottom of what was wrong. <\/p>\n Trial enters fifth week<\/p>\n Roberts gave evidence on Monday at the start of the fifth week of the trial underway in Nelson<\/a>, for a mother accused of abusing her child during medical treatment.<\/p>\n The mother, whose name is suppressed to protect the child\u2019s identity, has pleaded not guilty to four charges<\/a> of ill-treating a child and three charges of infecting with disease.<\/p>\n The mistreatment was alleged to have occurred over a 19-month period. The allegations arose from medical interventions<\/a> required for the child\u2019s assisted feeding and treatment for complex intestinal failure.<\/p>\n The defence argues the events that formed the charges arose from management of a \u201cmedically fragile child living with complicated medical devices\u201d and the actions of a desperate mother trying to help her child, who originally presented with suspected reflux disorder<\/a>, and failure to thrive.<\/p>\n However, in answer to a question from lead defence counsel Marie Dyhrberg, KC, if Roberts agreed Child X was a child with a complex medical condition, he said the child had unexplained symptoms, but ended up being \u201ccompletely normal\u201d and \u201cnot really complex at all\u201d. <\/p>\n Child \u2018never had intestinal failure\u2019<\/p>\n He said it was his professional opinion that Child X never had intestinal failure<\/a>, although the child may have had a degree of gastroesophageal reflux to begin with. <\/p>\n \u201cAfter exhausting all possible investigations, I concluded that there was no medical explanation for the symptoms reported by [the mother].\u201d<\/p>\n Roberts agreed later in cross-examination there were no reports of the mother directly harming the child while the child was on a ward.<\/p>\n He claimed it was not until Child X was in intensive care, when the mother was not by the bedside all the time, that staff were able to detect differences in the child\u2019s condition and behaviour.<\/p>\n \u201cIt\u2019s fair to say, we never gave up on trying to find medical cause,\u201d Roberts said.<\/p>\n Second opinion sought <\/p>\n Roberts was also the clinical director of the paediatric arm of the New Zealand National Intestinal Failure and Rehabilitation Service (NZ-NIFRS).<\/p>\n He reiterated previous witness statements about observations of Child X and how \u201csymptoms made no sense\u201d, despite interventions at hospitals around the country. <\/p>\n Roberts first met Child X in 2019, on admission to the hospital where he worked, of which the name and location was suppressed.<\/p>\n The child had been referred to Roberts\u2019 team for a second opinion after other doctors elsewhere reported the child\u2019s symptoms<\/a> \u201cdid not make complete sense\u201d and there was no clear diagnosis at the time.<\/p>\n Doctors had also reported concerns about the number of lines broken or dislodged, which required the child to be sedated with morphine to replace or re-insert them.<\/p>\n Eventually, Child X had so much morphine on board, Roberts said it was hard to know if the problem was the alleged feeding intolerance or the impact of the sedative on the child\u2019s body.<\/p>\n Roberts said the child also underwent bowel biopsies, all of which were normal.<\/p>\n Doctors also investigated the child\u2019s upper airway for (sleep) apnoea reported by the mother.<\/p>\n Infection follows hospital discharge<\/p>\n Child X was discharged in December 2019, following a multi-disciplinary team meeting where it was decided to reduce Child X\u2019s reliance on feeding via tubes.<\/p>\n