A mother accused of abusing her child during medical treatment was prepared to “flirt with the death of her child” for her own purposes, a court has been told.
Perversely, she then blamed the nurses and doctors who brought the child back from the brink, senior Crown prosecutor Mark O’Donoghue said.
The Crown and defence have delivered their hours-long closing addresses after a seven-week trial of a woman accused of “making a child sick, and keeping the child sick”, as one witness described it.
O’Donoghue said it was a “pithy summary” of the case prosecuted more in sorrow than anger.
“She needed [Child X] to be sick to keep playing her role as the medical mother of a sick child, attracting everyone’s sympathy and attention,” O’Donoghue alleged.
Hindsight ‘shaped witness views’
The defence has argued hindsight and “confirmation bias” have altered and shaped witness views over time.
In essence, there was no direct evidence of wrongdoing, defence lead Marie Dyhrberg, KC, said in her closing address.
It was a case built on what someone might expect to find and how that might influence recollections of what happened, she said.
“In the absence of contemporaneous concern, a pattern of deliberate harm becomes more difficult to sustain,” she said.
At the heart of the defence case was a “medically fragile child living with complicated medical devices” and the actions of a desperate mother trying to help her child.
Dyhrberg said the allegations against the mother were serious and carried serious consequences at an “extraordinary and devastating period of her life”.
The Crown 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.
The charges
The mother has defended charges of ill-treating a child and infecting with disease during lengthy and complex diagnosis and treatment for what was considered to be a gastrointestinal disorder, but first presented as reflux.
Child X was taken to the family’s local hospital in 2019 with symptoms of failing to thrive. It led to multiple admissions and interventions by many doctors, specialists and nursing staff in hospitals nationwide over the next 19 months.
None of them were able to get to the root of the problem, including reasons for the child’s apparent inability to eat by usual means.
Dyhrberg said the evidence showed claims around this were “far more nuanced”.
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.
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’s stomach and gut.
‘Unusual’ problems with lines and tubes
The Crown case sought to prove a total of seven charges against the mother, including ill-treatment of a child and infecting with disease.
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.
It was also alleged she fabricated symptoms in the child.
Some witnesses, including nurses and doctors, said problems with lines and tubes occurred with unusual frequency, and more than they had experienced before.
Charges around causing disease included allegations of deliberate contamination of the child’s central line.
Dyhrberg said accusations of deliberate contamination, which allegedly happened while the child was in a children’s intensive care ward, were serious and suggested clinicians were treating a problem they did not understand.
She said what the case revealed was a medically complex child treated across multiple teams, hospitals and clinicians, each holding only “part of the picture”.
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.
Dyhrberg said the Crown’s suggestion the number and frequency of cracked, snapped, disconnected and dislodged medical lines were “too unusual to be accidental and therefore deliberate” overlooked a critical point.
She said however unusual it might seem, it was important to ask what happened, who caused it and how.
“When 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.
“Again and again no one saw these events happen,” Dyhrberg said.
Science ‘no indication’ of when infections started
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 “jungle of bacteria”, were linked to infected lines.
The type of bacteria in the polymicrobial infections showed it likely came from the child’s own intestinal fluid, via a central line, raising questions over how it got there.
O’Donoghue said Child X would have felt miserable and without intervention might have died.
The child was admitted several times to a children’s paediatric intensive care unit in a tertiary hospital.
“Sometimes [Child X] was seriously ill, fighting for life with sepsis,” O’Donoghue said.
Dyhrberg said microbiology could not indicate when infection began and no one could say when, how, or who introduced the organisms.
She said neither homes nor hospitals were completely clean environments, but O’Donoghue said bacterial infections acquired in hospital were improbable given the strict hygiene steps staff took.
“It’s extremely unlikely procedures were not followed,” he said.
Serious illness ‘not in dispute’
Dyhrberg said it was not in dispute the case involved a “very sick child” who endured “serious medical complications and periods of clinical uncertainty”.
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.
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 “number of ways” events may have occurred.
“The law requires proof of deliberate conduct and not speculation,” she said.
O’Donoghue said the Crown had to prove the allegations built on circumstantial evidence beyond reasonable doubt.
He said it was, rightly, a high standard of proof, but suggested the body of circumstantial evidence transported the case “way beyond suspicion”.
He said the jury was required to be sure, but not necessarily certain in reaching its verdict.
Dyhrberg said the jury heard repeated reference throughout the trial to the term “medical child abuse”, which referred to a pattern of events, but the accused was not on trial for a pattern, but specific criminal charges.
Medical child abuse explained
Medical child abuse was described by O’Donoghue as a recognised form of abuse where a child received “unnecessary, potentially harmful medical care” at the instigation of a caregiver.
Oranga Tamariki said it was a recognised medical diagnosis, which was the conclusion a senior clinician reached in January 2021.
A report of concern was lodged with Oranga Tamariki and the child was removed from the mother’s care, and put into the care of a sister, who was the sole witness called by the defence.
A police investigation followed and the mother was charged in April 2023.
Child X was said to have undergone an almost immediate, “remarkable recovery”, including reintroduction to normal feeding, although the sister said the child, now at school, still suffered bouts of discomfort and was easily tired.
Dyhrberg said the child’s recovery was not a “miracle” but rehabilitation that involved careful, clinical management over some time.
She said the mother’s removal from the picture was not the only change.
“Remove the mum, look at the ending and you have the answer to everything that came before, but I urge you to look long and hard because it’s a dangerous way to reason.
“This was no miracle – this was not a child who suddenly woke up well, but this is far less convenient than what the Crown wants you to accept,” she said.
O’Donoghue said the prosecution was not required to prove motive or reasons, which may never be understood.
He alleged the evidence, including communication between the mother and family members, pointed to her seeing her position in life as her child’s doctor.
Dyhrberg said questions raised by medical staff over the mother’s “over-reporting” of problems were “used as a weapon against her”, when she was a parent who was present, attentive and who spoke up.
The trial before Justice Lisa Preston will continue after Easter, when the jury will begin deliberating before delivering a verdict.
