\u201cShe needed [Child X] to be sick to keep playing her role as the medical mother of a sick child, attracting everyone\u2019s sympathy and attention,\u201d O\u2019Donoghue alleged.<\/p>\n
Crown prosecutor Mark O’Donoghue says the case of a woman accused of deliberately harming her child during medical treatment was brought “more in sorrow than anger”. Photo \/ Stuff<\/p>\n
Hindsight \u2018shaped witness views\u2019<\/p>\n
The defence has argued hindsight and \u201cconfirmation bias\u201d have altered and shaped witness views over time.<\/p>\n
In essence, there was no direct evidence of wrongdoing, defence lead Marie Dyhrberg, KC, said in her closing address.<\/p>\n
It was a case built on what someone might expect to find and how that might influence recollections of what happened, she said.<\/p>\n
\u201cIn the absence of contemporaneous concern, a pattern of deliberate harm becomes more difficult to sustain,\u201d she said.<\/p>\n
At the heart of the defence case was a \u201cmedically fragile child living with complicated medical devices\u201d and the actions of a desperate mother trying to help her child.<\/p>\n
Dyhrberg said the allegations against the mother were serious and carried serious consequences at an \u201cextraordinary and devastating period of her life\u201d.<\/p>\n
The Crown<\/a> said while there were suggestions it was impossible to prove it was the mother, because there was no direct proof, it was the type of offending done when no one was watching.<\/p>\n The charges<\/p>\n The mother has defended charges of ill-treating a child and infecting with disease<\/a> during lengthy and complex diagnosis and treatment for what was considered to be a gastrointestinal disorder, but first presented as reflux.<\/p>\n Child X was taken to the family\u2019s local hospital in 2019 with symptoms of failing to thrive. It led to multiple admissions and interventions<\/a> by many doctors, specialists and nursing staff in hospitals nationwide over the next 19 months.<\/p>\n None of them were able to get to the root of the problem, including reasons for the child\u2019s apparent inability to eat by usual means<\/a>.<\/p>\n Dyhrberg said the evidence showed claims around this were \u201cfar more nuanced\u201d. <\/p>\n She said Child X wanted food, would sometimes taste it and eat small amounts, but the problems were what happened after, including pain and bloating.<\/p>\n At the time, doctors had resorted to feeding Child X liquid nutrition and giving medicine via an array of different lines, including intravenous and surgically inserted tubes into the child\u2019s stomach and gut.<\/p>\n \u2018Unusual\u2019 problems with lines and tubes<\/p>\n The Crown case sought to prove a total of seven charges against the mother, including ill-treatment of a child and infecting with disease.<\/p>\n It was alleged she tampered with the array of lines and tubes used to deliver nutrition, causing them to break, disconnect, become dislodged and infected.<\/p>\n It was also alleged she fabricated symptoms in the child.<\/p>\n Some witnesses, including nurses and doctors, said problems with lines and tubes occurred with unusual frequency, and more than they had experienced before.<\/p>\n Charges around causing disease included allegations of deliberate contamination of the child\u2019s central line.<\/p>\n Dyhrberg said accusations of deliberate contamination, which allegedly happened while the child was in a children\u2019s intensive care ward, were serious and suggested clinicians were treating a problem<\/a> they did not understand. <\/p>\n She said what the case revealed was a medically complex child treated across multiple teams, hospitals and clinicians, each holding only \u201cpart of the picture\u201d.<\/p>\n She said the evidence did not account for human error, repeated line access by multiple caregivers, and at-home care of a child being encouraged to live as normal a life as possible and exposed to a number of potential sources of infection.<\/p>\n Dyhrberg said the Crown\u2019s suggestion the number and frequency of cracked, snapped, disconnected and dislodged medical lines were \u201ctoo unusual to be accidental and therefore deliberate\u201d overlooked a critical point.<\/p>\n She said however unusual it might seem, it was important to ask what happened, who caused it and how. <\/p>\n \u201cWhen you move away from that, what emerges is not a series of proven acts of interference but a series of events where those questions remain unanswered.<\/p>\n \u201cAgain and again no one saw these events happen,\u201d Dyhrberg said. <\/p>\n Science \u2018no indication\u2019 of when infections started<\/p>\n The prosecution alleged a repeated pattern of mysterious and serious bacterial infections in the child with unusual features, including what one doctor described as a \u201cjungle of bacteria\u201d<\/a>, were linked to infected lines.<\/p>\n The type of bacteria in the polymicrobial infections showed it likely came from the child\u2019s own intestinal fluid, via a central line, raising questions over how it got there.<\/p>\n O\u2019Donoghue said Child X would have felt miserable and without intervention might have died.<\/p>\n The child was admitted several times to a children\u2019s paediatric intensive care unit<\/a> in a tertiary hospital.<\/p>\n \u201cSometimes [Child X] was seriously ill, fighting for life with sepsis<\/a>,\u201d O\u2019Donoghue said.<\/p>\n Dyhrberg said microbiology could not indicate when infection began and no one could say when, how, or who introduced the organisms.<\/p>\n She said neither homes nor hospitals were completely clean environments, but O\u2019Donoghue said bacterial infections acquired in hospital were improbable given the strict hygiene steps staff took.<\/p>\n \u201cIt\u2019s extremely unlikely procedures were not followed,\u201d he said.<\/p>\n Serious illness \u2018not in dispute\u2019<\/p>\n Dyhrberg said it was not in dispute the case involved a \u201cvery sick child\u201d who endured \u201cserious medical complications and periods of clinical uncertainty\u201d.<\/p>\n However, it was human nature for events to appear differently over time. The law required the jury to look at what happened at the time, what was recorded, observed, said and understood.<\/p>\n Dyhrberg said among the seven charges against the mother, the Crown did not allege a single, clearly defined act but framed its argument in the alternative, suggesting a \u201cnumber of ways\u201d events may have occurred.<\/p>\n \u201cThe law requires proof of deliberate conduct and not speculation,\u201d she said.<\/p>\n O\u2019Donoghue said the Crown had to prove the allegations built on circumstantial evidence beyond reasonable doubt. <\/p>\n He said it was, rightly, a high standard of proof, but suggested the body of circumstantial evidence transported the case \u201cway beyond suspicion\u201d.<\/p>\n He said the jury was required to be sure, but not necessarily certain in reaching its verdict.<\/p>\n Dyhrberg said the jury heard repeated reference throughout the trial to the term \u201cmedical child abuse\u201d, which referred to a pattern of events, but the accused was not on trial for a pattern, but specific criminal charges.<\/p>\n Medical child abuse explained<\/p>\n Medical child abuse<\/a> was described by O\u2019Donoghue as a recognised form of abuse where a child received \u201cunnecessary, potentially harmful medical care\u201d at the instigation of a caregiver.<\/p>\n Oranga Tamariki said it was a recognised medical diagnosis, which was the conclusion a senior clinician reached<\/a> in January 2021. <\/p>\n A report of concern was lodged with Oranga Tamariki and the child was removed from the mother\u2019s care, and put into the care of a sister, who was the sole witness called by the defence<\/a>.<\/p>\nDefence counsel lead, Marie Dyhrberg, KC, says hindsight and confirmation bias had altered and shaped witness views over time. Photo \/ Tracy Neal<\/p>\n
The trial of a woman accused of medically abusing her child is being heard in the High Court at Nelson before Justice Lisa Preston (inset). The Crown and defence have now delivered their closing addresses. Image \/ NZME composite; RNZ inset<\/p>\n