S03 Ep07 RERUN: Trial of the Century

Summary

Nobody Should Believe Me
Season 03, Episode 07: "Trial of the Century" (Rerun)
Release Date: May 9, 2025

Hosted by Andrea Dunlop
Produced by True Story Media

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Introduction

In this rerun of Season 3's "Trial of the Century," Andrea Dunlop delves into the high-stakes Kowalski v. Johns Hopkins trial. This case has been under intense scrutiny for nearly two years, paralleling the ongoing Rady Children's lawsuit. Dunlop provides a comprehensive analysis of the trial's developments, expert testimonies, and the intricate dynamics between the opposing legal teams.

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Overview of the Kowalski v. Johns Hopkins Trial

The Kowalski case centers around allegations that Johns Hopkins failed to correctly diagnose Maya Kowalski with Complex Regional Pain Syndrome (CRPS), leading to inappropriate treatments and ultimately costing Biata Kowalski her life. The plaintiffs accuse Johns Hopkins of medical malpractice, negligent hiring and supervision, fraudulent concealment, and emotional distress, among other charges. Over six years, the case has seen a reduction from 20 to five major counts, reflecting the complexities and prolonged legal battles involved.

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Opening Statements: Two Sides of the Story

Plaintiff's Argument: Gregory Anderson, lead attorney for Jack Kowalski, asserts that Johns Hopkins overlooked Maya's CRPS diagnosis on seven occasions.

“Johns Hopkins missed a diagnosis of complex regional pain syndrome on seven different occasions.” ([06:59])

Anderson contends that despite knowing Maya's condition, the hospital proceeded with inappropriate treatment, effectively "kidnapping her from her family," which they argue led to Biata's tragic suicide.

Defense's Stance: Howard Hunter, lead attorney for Johns Hopkins and All Children’s, refutes these claims by emphasizing the hospital's lack of intent to harm.

“We had no reason to wish this family harm, and we still don’t.” ([08:15])

Hunter underscores that the hospital acted within medical standards, denying any connection between their actions and Biata's suicide.

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Legal Proceedings and Charges

As the trial progresses, the charges have been meticulously narrowed:

1. False Imprisonment: Now limited to the period between Maya's admission to Johns Hopkins and the subsequent Department of Children and Families (DCF) order.
2. Battery: Focused solely on unauthorized photographs taken of Maya prior to her court appearance.
3. Medical Malpractice: Claims that Johns Hopkins violated the standard of care during Maya's treatment.
4. Negligent Hiring and Supervision: Pertaining to the actions of Kathy Beatty and other Johns Hopkins doctors.
5. Fraudulent Concealment: Allegations of withholding exculpatory evidence during Maya's EEG evaluations.
6. Insurance Fraud: Remaining a contested charge with parts both removed and retained.
7. Emotional Distress: Both negligent and intentional infliction claims related to Biata's death and Maya's PTSD.

The reduction from 20 to five charges over six years underscores the trial's complexity and the challenges in substantiating the plaintiffs' claims.

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Jury Dynamics and Selection

Andrea Dunlop expresses concern over the jury's capacity to absorb the trial's extensive and technical information.

“Jury selection is a misnomer because when you come into the courtroom as a litigant, you’re really engaging in a process of deselecting jurors you don’t want.” ([14:01])

The current jury appears engaged and inquisitive, actively seeking clarity on procedural matters, suggesting a commitment to impartiality and thorough deliberation.

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Expert Testimonies: CRPS vs. Medical Child Abuse

Defense Medical Experts: A significant majority of defense testimonies challenge the legitimacy of Maya's CRPS diagnosis, suggesting instead that Maya was subjected to medical child abuse, specifically Munchausen by Proxy (MBP).

• Dr. Elliott Crane (Stanford):
  Describes the standard treatment for CRPS as functional, involving therapies rather than high-dose medications.

  “Most of our patients are females who have CRPs. We don’t know why that is, but 10-year-old girls with CRPs are our favorite to take care of because they recover the fastest.” ([42:03])

  Dr. Crane dismisses the extreme treatments Maya received, highlighting inconsistencies with typical CRPS presentations.

Plaintiff Medical Experts: Contrastingly, the plaintiffs argue that Maya's severe condition warranted the aggressive treatments administered by Johns Hopkins. They emphasize the dire prospects without such interventions.

Dr. Sally Smith (Child Protection Team): Her testimony was pivotal in countering claims of MBP. Dr. Smith maintains that her evaluations indicated evidence of medical child abuse, challenging the plaintiffs' narrative.

“Medical child abuse is a child abuse pediatric diagnosis. There is a parallel track in psychiatry... I am very well trained to evaluate medical child abuse based on my child abuse pediatrics experience and board certification.” ([52:42])

Her direct and authoritative approach in court aims to substantiate the allegations against Biata Kowalski.

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Critical Testimonies and Cross-Examinations

Dr. Sally Smith vs. Gregory Anderson: A heated exchange occurred during cross-examination, where Anderson accused Dr. Smith of not reporting Dr. Kirkpatrick's warnings against pursuing MBP claims.

“Yeah, except for the fact that you did not tell anyone in that report that he had warned you off of going after the Kowalski’s.” ([50:12])

Dr. Smith rebuked this, emphasizing her role focused solely on assessing evidence for child abuse without delving into the broader implications or internal hospital dynamics.

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Biata Kowalski's Personal Accounts: The Letters

A compelling aspect of the trial involves letters written by Biata Kowalski, purported to be in Maya's voice, detailing her experiences during Maya's ketamine coma treatment in November 2015. These letters reveal:

• Medical Complications:
  Biata describes severe adrenal insufficiency and the high-risk nature of the ketamine coma procedure.

  “Despite the risks and complications, there are several good things going for me right now... I am hoping for a miracle. Ketamine coma, exclamation point, smiley face.” ([64:27])

• Emotional Struggle:
  The cheerful tone juxtaposed with the gravity of Maya's condition raises questions about Biata's motives and emotional state during the treatment period.

“I have very high tolerance for drugs. If I was a horse, I would be comatose or dead already.” ([68:25])

These letters have drawn significant public attention, echoing previous cases like Mary Welch's, where parental narratives conflicted sharply with medical evidence.

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Analysis of Plaintiff's Narrative vs. Medical Evidence

Andrea Dunlop critiques the plaintiffs' reliance on emotional appeal over factual evidence. She highlights discrepancies between public portrayals (e.g., in media and films) and the documented medical realities of Maya's condition.

“The plaintiff’s strategy is just that. All heartstrings, no skepticism.” ([60:25])

Dunlop emphasizes that while the plaintiffs create a compelling emotional narrative, the overwhelming medical testimonies challenge the validity of their claims, potentially leaving the jury conflicted between empathy and factual analysis.

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Pending Verdict and Future Implications

With the verdict imminent, the trial's outcome promises significant ramifications for the medical community's handling of CRPS and suspected medical child abuse cases. The verdict will not only determine the liability of Johns Hopkins but also influence future protocols and accountability measures within pediatric care settings.

Andrea Dunlop anticipates discussing Maya Kowalski's personal testimony and the trial’s verdict in the forthcoming episodes, underscoring the case's profound impact on all parties involved.

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Conclusion

"Trial of the Century" offers an in-depth exploration of the Kowalski v. Johns Hopkins case, highlighting the intricate balance between medical diagnoses, legal accountability, and personal narratives. Andrea Dunlop adeptly navigates the complexities of the trial, providing listeners with a nuanced understanding of a case that sits at the intersection of healthcare and the legal system.

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Notable Quotes:

• “Johns Hopkins missed a diagnosis of complex regional pain syndrome on seven different occasions.” — Dr. Bex ([06:59])

• “We had no reason to wish this family harm, and we still don’t.” — Howard Hunter, Johns Hopkins Attorney ([08:15])

• “Medical child abuse is a child abuse pediatric diagnosis...” — Dr. Sally Smith ([52:42])

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For more detailed discussions and exclusive content, subscribe to True Story Media’s Patreon or follow on Apple Podcasts.

Transcript

[Andrea Dunlop]

Foreign.

[Dr. Bex]

You may notice that this episode is coming a day later than usual and also that it's not the episode you were expecting. So we will be continuing our coverage of the Rady children's lawsuit next week, but we ended up needing to re record some things for this episode, so that is why it will be a little bit late. Covering a case that is unfolding in real time can be a challenge and we want to make sure we are as accurate and precise as humanly possible and frankly that takes time and resources. I could not ask for a better team than the one I have on this show, but we are an independent production and I would rather be late with an episode than miss something important. So today we're sharing a very on theme rerun from season three discussing the goings on of the Kowalski v. Johns Hopkins trial right before the verdict came in. We have been covering this case for almost two years now now on both the main feed and the Patreon, and there are many parallels between this case and the Rady children's lawsuit. I've also made all of the subscriber episodes about the Kowalski trial available on the free tier of Patreon this month. If you want to go and do a super deep dive, we have about a billion episodes about this trial. There's also a ton of other exclusive subscriber content available there and on Apple podcasts, including this month our conversation about Elizabeth Finch and the Anatomy of Lies on Peacock. And if you subscribe on either of those places, you will get all eight episodes of season six on the launch date June 19th. Subscribing is the best way to support the show, but if monetary support is not feasible right now, we totally get it. Rating and reviewing the show, leaving comments on Spotify, spreading the word anywhere you talk to people, and shopping our sponsors are also great ways to support and help me be able to pay the fine. Folks who I could not do this work without, such as my incredible right hand and lead producer Mariah Goff Fawcett, our eagle eyed producer and editor Greta Stromquist, my Fabulous co host Dr. Bex, our top of the line sound engineer Robin Edgar, and last but most certainly not least our research producer and fact checker Aaron Ji who keeps us clean, cute and out of court. We'll be back with a new episode next week and in the meantime, let's go back briefly to 2023. Were we ever so young? Before we begin, a quick warning that in this show we discuss child abuse and this content may be difficult for some listeners. If you or anyone you know is a victim or survivor of medical child abuse, Please go to munchausensupport.com to connect with professionals who can help people believe their eyes. That's something that actually is so central to this whole issue and to people that experience this is that we do believe the people that we love when they're telling us something. If you questioned every thing that everyone told you, you couldn't make it through your day. I'm Andrea Dunlop and this is Nobody should believe me. Just a quick reminder that my new book, the Mother Next Medicine, Deception and Munchausen by Proxy is on sale right now wherever books are sold. The book was an Amazon Editor's pick for nonfiction and the Seattle Times called it a riveting deep dive into mvp. And if you are an audiobook lover and you like hearing my voice, which I'm assuming you do since you're listening here, you should know that I narrate the audiobook as well. If you have already read the book, which I know so many of you have, thank you so much. Please let me know your thoughts and [e-mail] and we will bring my co author Detective Mike Weber on for a little book Q and A and post retirement. Tell all special thanks for your support ladies. You'll end up shopping for your guys deodorant right? So try Degree's original Cool Rush. You see, last year Degree changed the formula and men were mad. One guy even started a petition so DAG admitted they messed up and brought the original Cool Rush scent back. It's clean, crisp and actually smells like someone you wanna cuddle. And it's in Walmart, Target and other stores now for under $4. So toss one in your cart and find out why it's the best selling men's antiperspirant for the last decade. Degree Cool Rush is back and it's so smells like Victory. If you'd like to support the show, you can subscribe on Patreon and Apple podcasts where you will get all episodes early and ad free, as well as tons of bonus content including weekly recaps of the Kowalski trial, which is happening now with me and our Florida pediatrician friend. If monetary support is not an option, rating and reviewing always helps, as does telling friends about the show on social media or wherever you talk to people. To say that the Kowalski vs. Johns Hopkins trial has been dominating my life for the past seven weeks is an understatement. In addition to continuing to parse through just These, like, thousands of pages of documents from the past six years of legal back and forth that are in the public record. I've been watching almost all of the testimony which has been airing live on Law and Crime's YouTube channel. So big thanks. Thanks to those guys for putting that out. It's airing a couple other places as well. But if you are listening on Apple subscriptions and Patreon, you know that the Florida doctor friend that we spoke to earlier this season has gone right down this rabbit hole with me. So thankfully, I'm not completely alone here. And also shout out to the Reddit crowd. I've seen some really incredible insights from doctors, lawyers, and just people that are watching this trial. And honestly, you guys give me hope for the social media discourse. So, you know, for the past month and a half, I feel like my life has been really bifurcated in this weird way. Like, in the outside world, I know that people mostly kind of just have a passing notion that this trial is happening. You know, maybe they saw the movie, they've seen a few headlines. But for those of us who are in the medical child abuse world, I mean, this is like OJ Simpson level big. This trial is going to have a massive impact on our work going forward. So what has been going on down there in that nondescript little Florida courtroom where I've been spending so much of my mental time as this episode airs? We may be days away from a verdict in this case, and you can bet that we will update you as soon as that happens. But let's begin with the narratives that have been laid out by the opposing sides in the case, which we saw most succinctly in their opening statements. This is the lawyer's chance to tell the jury not what the evidence is, is specifically, but what the evidence will show them. So it's like the story of the case through their eyes. Here is the lead attorney for Jack Kowalski, Gregory Anderson. And this is from Court tv.

[Andrea Dunlop]

Johns Hopkins missed a diagnosis of complex regional pain syndrome on seven different occasions.

[Dr. Bex]

So basically, Maya has crps. Johns Hopkins missed the diagnosis and according to Anderson, and they knew it and proceeded anyway, giving her the wrong treatment and kidnapping her from her family. And these decisions cost Biota her life.

[Andrea Dunlop]

But we will prove that the continued.

[Jonathan Leach]

Allegations that she was crazy and that.

[Andrea Dunlop]

She was trying to harm her own children.

[Dr. Bex]

If you've seen the film, you get the gist of the argument that they're making. This is a really emotional story. You know, during the opening statements, they play this 911 call. We played a little bit of it on our show. I honestly can barely listen to the whole thing. You can hear Maya's little brother Kyle screaming in the background, you know, and they're playing this in court while Jack Kowalski is sitting front and center with both of his children. It's really, you know, I mean, it's a really emotional moment. Now, of course, Johns Hopkins has a whole different take on what the facts are gonna show. Here is Howard Hunter. He's lead attorney for Johns Hopkins, All Children's. And this is his opening statement on Court tv.

[Andrea Dunlop]

We had no reason to wish this.

[Dr. Bex]

Family harm, and we still don't.

[Andrea Dunlop]

Indeed, there's a tragic outcome in this case in terms of Mrs. Kowalski's suicide, and we regret very much that that happened. The issue here, however, is who's responsible for it. And we're going to go over the facts of that and what the facts don't show in terms of any connection between what was done by all children and that tragic result.

[Dr. Bex]

So whose version of events will prevail and what have we learned since this trial started? Today we're going to talk about what charges are still on the table, who's testified so far, and some of the bombshells that have come out during trial. And we brought in a guest to help give us an expert perspective on this trial.

[Andrea Dunlop]

My name is Jonathan Leach. I am a sole proprietor trial consultant, sometimes known as a jury consultant. I am also a Texas attorney, and I have been in the trial consulting business for about 25 years, going back to the late 1990s.

[Dr. Bex]

So Jonathan is a fellow member of the American Professional Society on the Abuse of Children's Munchausen by Proxy Committee. So he's deeply knowledgeable about a variety of the issues that have come into play in this case. So a trial consultant is an expert who comes in, and his bottom line role is to really help a litigant so party in a lawsuit or a criminal criminal matter, communicate the case as effectively as possible to the jury.

[Andrea Dunlop]

So that encompasses jury research, possibly mock trials or focus groups to help understand how the case plays to folks in a particular jurisdiction, whatever part of the country the court actually is seated in, and then working with witnesses to help them prepare for trial, help them figure out how to communicate effectively with the jury, establish rapport, get their message across, speak at a jury level. It encompasses things like visuals, demonstrative aids, graphics to communicate the case to the jury that way. So a lot of different tools come into play, but the gist is to help a jury understand as efficiently as possible. What happened?

[Dr. Bex]

The central cast of lawyers in this trial. So you've got Nick Whitney and Gregory Anderson on the Kowalski side, Howard Hunter, Ethan Shapiro and Patricia Crowles on the Johns Hopkins side. These guys have taken on the contours of, like, reality television stars. For me, you know, each side has their bulldog, so that's Anderson and Hunter, respectively. And then each side has their softer touch, which is Whitney and Shapiro. And then there is Judge Hunter Carroll, who is the Andy Cohen of this very messy Housewives franchise. It's been actually really interesting to see these people interacting after having read so much about them, reading all of these depositions, reading all of these motions, and. And you can see as they're interacting with each other, these sort of flares of animus, these bits of camaraderie. They have been at this for six years, and it really shows. And this trial, it's grueling. Here's Jonathan.

[Andrea Dunlop]

I think what we see in the courtroom is the tip of the iceberg in terms of the amount of effort that the two trial teams are having to put in. You know, it is typical to leave the courtroom at 5, 5:30 to go immediately to the trial preparation room, sometimes called the war room. And in some sense, the workday begins at say 6pm and goes into the wee hours. And it's always. You're always responding to curveballs, to sudden developments that took place that day in the courtroom.

[Dr. Bex]

And then you have the six members of the jury, the people who are actually going to decide this thing, and they are sort of sitting off camera like a great chorus. And being on a jury like this is. Is no joke.

[Andrea Dunlop]

I think really one of the first things I'm concerned about in this case is the length of the trial and the complexity of the issues. Jury selection is a misnomer because when you come into the courtroom as a litigant, what you're really doing is engaging in a process of deselecting jurors that you don't want. But having said that, you would want to develop a profile of jurors you think will be most amenable to your side of the case, always keeping an eye out for those who are potentially dangerous to your case. I think if you're working with a defense in this case, what you're looking for is a person who will take to heart the instruction to wait for the entire story. As we know, plaintiff gets to go first. Plaintiff will do its very best during its case in chief to put over the most aggressively pro plaintiff version of the story that it Can't. And of course you want jurors at that point still to be willing to hear from the other side not to be so emotionally inflamed that they can't calm down and listen to the other version of the case. If you're the defense again and you're looking for markers of the ability to delay gratification. And I think in this case that means just as examples, maybe folks with advanced degrees, people who have pursued educational path maybe longer than others, people who appear to be in good health, who will give answers on the questionnaires that suggest that they are capable of listening calmly and patiently to the entire case and sort of navigating through some of these. I saw this medical testimony is very complex. Some of the legal issues, the orders that have come down are hard to navigate.

[Dr. Bex]

And as to what the plaintiff wants, according to Jonathan, more or less the.

[Andrea Dunlop]

Opposite in a sense. What's happening one version of this case is that Biada Kowalski is being put on trial. And so as a plaintiff attorney, I'm looking for folks who will identify, I think, with Beata's plight, who will emotionally, psychologically put themselves in her position and view the whole narrative through Biata's eyes. Perhaps someone who is more prone to think, maybe emotionally rather than being coldly rational about things. Looking to deselect the folks that I think are favorable to the defense. So the higher level education folks, the folks who have been established in the same career for a long time, the folks whose life history suggests a lot of stability, those are the people that I think I want to strike as the plaintiff attorney because I'm looking for the opposite.

[Dr. Bex]

So what is the jury being asked to decide on at this point? The charges have been narrowed over the six years that this lawsuit has dragged on as the judge has issued what are called directed verdicts. Here are the current charges as they stand. From the 8th amendment to the original complaint. There is a count of false imprisonment, though this has been narrowed considerably to the days between the admission to Johns Hopkins and the DCF order coming down as it's been determined already that this original call was made in good faith. Battery is still in, but also considerably narrowed. Now it is only regarding the incident involving the photographs that were taken of Maya before her court appearance. There is medical malpractice for this. They have to prove that Johns Hopkins violated this standard of care while Maya was with them. There is negligent hiring and supervision and training of Kathy Beatty and a separate charge for all of the doctors at Johns Hopkins. There's a Charge of fraudulent concealment. This has to do with a video allegedly taken while Maya was in the EEG room. This is a room where they do certain types of testing. And the plaintiff claims this video contains exculpatory evidence that was allegedly kept from them. Allegedly. There is one count remaining for the insurance fraud. This is honestly the most confusing to me because parts of it have been taken out, parts of it remain. Big question mark about this one. And there's account for negligent infliction of emotional distress and a separate count for intentional infliction of emotional distress. So these have both been somewhat narrowed. And these are the counts related to Biata's death and its effects on the family and Maya's PTSD from her time in the hospital. This list has been cut down from the original 20 counts. That list included things like false reporting, civil conspiracy, malicious prosecution, and wrongful death. So you can see why this has taken six years. And what about those false imprisonment claims? This has been central to the Kowalski narrative about Johns Hopkins, all children's who claim that they kept Maya there to punish Biota and to be able to bill their insurance for a condition that they didn't believe she had. What we now know is that in fact, Johns Hopkins was not trying to keep her there.

[Andrea Dunlop]

And at a neutral shelter hearing, which is in October of 2016, what I show here is that the guardian ad litem actually says, you know, we're in a tough spot here. I think he says, all of us agree that she needs to be transferred to the appropriate place. We just don't know where that is. Were having a hard time figuring out where that could be. So, yeah, what comes through is this kind of desperation on all parties. Let's figure out what the best plan is and let's do that now. With respect to the specific plan to transport her to Nemours, my understanding is, I think I saw testimony on this that there was, at least from the hospital's viewpoint, a meeting of the minds. Right. We all agree this is what should happen, and then the very next day, the hospital discovers that now the Kowalskis aren't part of that plan after all. We thought we had a plan yesterday, and then today it's, no, we're not. We're not taking her there.

[Dr. Bex]

So this is about an attempt to transfer Maya to Nemours, a hospital with a pediatric pain clinic that they felt could better care for her, regardless of whether her pain was due to CRPS or conversion disorder. However, Biota wasn't interested in transferring Maya after she found out that they wouldn't perform a specific procedure she was looking for. Here is Dr. Santana Rojas, the director of Pediatric Pain Management from Nemours, and she's explaining. This is from the Law and Crime Network's coverage of the case.

[Jonathan Leach]

I just remembered that she mentioned several times that her daughter suffered from complex sugar and pain syndrome and that she.

[Dr. Bex]

Wanted her to have an intrathecal pump placement.

[Jonathan Leach]

And my response to her was that I don't provide that treatment for that.

[Dr. Bex]

Condition, but I'll be happy to see her in the outpatient setting in the clinic to make an evaluation and recommendations.

[Jonathan Leach]

Which for complex trigger and pain syndrome.

[Dr. Bex]

We have a standard program in our.

[Jonathan Leach]

Clinic where we keep the patients for.

[Dr. Bex]

An average of a month, Monday to.

[Jonathan Leach]

Friday, doing physical therapy, occupational therapy and behavioral therapy every day.

[Dr. Bex]

There were several other attempts to transfer her throughout her stay, but once the DCF case was underway, none were successful. There's also a big question about timing. And Biota and Jax attempts to leave the hospital before the shelter order. Jack claims that during this period, they threatened to call the police if they tried to leave with Maya, against medical advice. So I asked our doctor friend about this, and she said there are some situations where a hospital might have to call the police in a situation where it's physically dangerous, for example, for parents to remove a child from the hospital. It's not clear exactly what happened here, which is, I think, why this count remains, but only for, again, that short time period. So which of these charges might be the most viable? Here's Jonathan.

[Andrea Dunlop]

I think if I'm the plaintiff's attorney. I'm sorry, feeling maybe more confident about the negligence claim, that is the negligent infliction of emotional distress claim, than maybe the malpractice claim. Just because I think when the jury sits down with the verdict form, they will not have a difficult path to navigate there from things that the hospital would have, could have, should have done in order to prevent all this. I think what we're seeing so far at least, is a little bit of fuzziness about what exactly is the protocol? What is the standard operating procedure? You and I can explain maybe why the 85 days elapsed or the 87 days elapsed. But, you know, it proved to me that the hospital was assertively, aggressively trying to find a plan B for this little girl. I'm thinking that NIED claim looks pretty promising, maybe for the plaintiff.

[Dr. Bex]

What do we know about this jury and how they're taking all of this in? You know, we can't see them for obvious reasons. But we do hear from them in the form of questions that they are permitted to ask each witness because of.

[Andrea Dunlop]

The questions they're asking. This seems to me to be a very engaged, thoughtful, serious jury. For example, can we see the shelter order? Can we see a copy of the shelter order? That is, this is a jury that wants to know what were the rules of the game, what's the governing standard, what's the protocol here? So my prediction is that with this particular jury, they're going to do their best to give both sides a fair shake and really work diligently to arrive at the right decision.

[Dr. Bex]

I agree with this take in the beginning at least. So we did record this interview earlier in the trial. As it's worn on, I've become increasingly concerned that at least a few of the jurors are not really getting it. You know, I've heard a lot of questions to the tune of oh, is such and such person an expert in CRPs? Which really plays into the idea that you would have to be to identify this abuse. Anyway, it can be so daunting to make an appointment for something. First you have to call, then they call you back inevitably, right as your six year old absolutely needs to ask you an existential question and then you have to coordinate your hot mess of a calendar. Okay, parts of that example were very specific to me, but scheduling appointments with dentists, doctors, therapists can be a real hurdle, which is why I lean on ZocDoc for help. ZocDoc is a free app and website where you can search and compare high quality in network doctors and click to instantly book an appointment. You can book in network appointments with more than 100,000 doctors across every specialty from mental health to dental health, primary care and more. You can filter for doctors who take your insurance, are located nearby, and are highly rated by verified patients. Once you find the right doctor, you can see their actual appointment openings. Choose the time slot that works for you and click to instantly book a visit. So no phone tag. So stop putting off those doctor's appointments and go to Zocdoc.com to find and instantly book a top rated doctor today. That's Zocdoc.com nobody. Zocdoc.com nobody. You can find all of that info at the link in our show notes and remember that supporting our sponsors is a great way to support the show. You know, I love quints. I talk about it here. I talk about it in my real life. My friends love quints. My producer Mariah loves quints. My mom loves quints. I am wearing a Quint T shirt right now. No exaggeration. I think probably half of my clothes are from this brand at this point. So it is finally warming up here in the Pacific Northwest. And I popped over to Quince for a little summer refresh and boy did they deliver. They have this brand new linen collection which is my absolute favorite thing to wear in the summer with dresses, skirts and shorts starting at $30. And they have a linen jumpsuit in a whole bunch of colors and patterns that I am going to be living in this summer. I love a jumpsuit. Everything with quince is priced 50 to 80% less than what you'd find at similar brands. By working directly with top artisans and cutting out the middlemen, Quince gives you luxury without the markup. And Quince only works with factories that use safe, ethical and responsible manufacturing practices. So you can feel good about shopping with them. So treat your closet to a little summer glow up with quince. Go to quince.com believe for free shipping on your order and 365 day returns. That's quince.com believe to get free shipping and 365 day returns. Quince.com believe you can find that info at the link in our show notes. And remember that shopping our sponsors helps support the show. Unsurprisingly, the vast majority of people who've taken the stand in this trial have been medical professionals of some kind. And there is just so much information coming at this jury. I do not envy them.

[Andrea Dunlop]

There's always a danger that they get overwhelmed. I think the lesson really is a lesson to the trial team, whether it's plaintiff or attorney. I think everybody on both trial teams has to recognize, look, this is a lot of work we're asking each jurors to do. How can we make this process the next whatever it is, six weeks, make it as easy as possible for them. Dr. Chopra, interestingly, has demonstrated that he understands that very well. He faces the jury, he addresses them directly, he makes jokes. He's sort of lighthearted about the amount of the number of medical records he's looked through. He's connected very well with them.

[Dr. Bex]

As we've discussed, Dr. Chopra was on the stand for an entire day. And I don't really honestly know how the jury was able to track everything he said. Importantly, he only saw Maya one time. So mostly he was there talking about CRPs in general. In the film, Dr. Chopra was positioned as this neutral expert who came in and gave this diagnosis. Now he was hired by the Kowalskis and my suspicion is that he was selected by BIADA because of his beliefs about, quote, misdiagnosis of Munchausen by proxy in parents of CRPS patients and his apparent stance that medical child abuse basically doesn't exist. And as we've discussed before with experts like Dr. Carol Jenny, just because you can find a doctor or two to reinforce a belief doesn't mean that it's legitimate diagnosis.

[Andrea Dunlop]

I think what we know is that there are MDs out there who are of that camp and who are, I won't say we'll issue a made to order opinion, but are very amenable to moms, typically moms who make this sort of complaint of some exotic illness.

[Dr. Bex]

And this seems to be really central to the plaintiff's strategy to insist that CRPS is not only this exotic thing that for some reason only Dr. Chopra and Dr. Kirkpatrick, both of whom reject the medical consensus around CRPS and ketamine treatments, are qualified to diagnose. And furthermore, that Maya had the most unusual exotic case of it that was somehow both extremely severe and yet so subtle that all of these other doctors misdiagnosed her. Every medical argument from the defense seems to be answered with either the pain just comes and goes or that the person asking just doesn't understand CRPs. And as a reminder, Dr. Kirkpatrick is a, quote, expert in CRPs because he says he is. There's no board certified subspecialty in the disease and the subspecialties you would look for, such as neurology, pain management and anesthesia. He also doesn't have any of those or any board certification at all. As we discussed in the last episode, one of the biggest bombshells regarding this CRPS diagnosis came out in the last two weeks, and that is that the diagnosis predated Dr. Kirkpatrick, who was the first person to officially diagnose it. Biota reported to another doctor. A week before ever seeing Dr. Kirkpatrick. She reported to this pulmonologist, Dr. Kreisman, that Maya had a diagnosis of CRPS. So what I gleaned from that is that she had had this conversation with her patient's daughter about crps. We already know about that. It was in the psych eval of Biata. They talked to this person who had first told her about CRPS and told her about Dr. Kirkpatrick, that she talked to that person, that she decided that was Maya's diagnosis because she was reporting it to other doctors before she ever had any diagnosis of crps. So which of these dueling doctors should, we believe, given that they've at this point been divided into sides and this has been a problem all the way through this case. What they really needed was an expert who could break the tie. And that was almost impossible once Munchausen by proxy was in the mix. Here's Jonathan.

[Andrea Dunlop]

I think in this case, the specific wheel that was turning very slowly was the search for an independent expert. Where is the independent expert who can come in here and weigh in on this case and evaluate for the benefit of the court what's really going on with this child? I think in the shelter hearing what comes through is almost the, the desperation of the judge. The judge is practically begging for somebody to come rescue them, someone with independent expertise to come in and evaluate the case. And no one can find one. They're hard to find. These people are very specialized. They're few and far between. They are rare experts. And in this case In October late 2016, the court just cannot find one.

[Dr. Bex]

And what area of expertise, like when you say an expert? Because I think then a lot of people are like, well, an expert in CRPs or an expert in. What are you looking for expertise in? Specifically during the shelter here, the very.

[Andrea Dunlop]

Initial shelter here, the two possibilities that were raised were someone with expertise in pediatric psychiatry, someone with expertise in pediatric neurology. So those would be just two examples. Now, as soon as someone with those qualifications understands what they're being asked to do, many of them run the other way. That is, oh, this is a lot. This is a potential lawsuit. This is a disputed matter. This has all the indications of going into the legal system. I'm going to have to review thousands of pages of medical records. I want no part of this. Now, I don't know to what extent that attributes to the 85 or 87 day stay in the hospital, but I think based on what I've read, it is a very significant reason for that long time period.

[Dr. Bex]

The plaintiffs have finished up at this point, so we've heard their arguments other than what is going to come up in cross examination. And it has been rocky. There have been several calls from both sides for a mistrial. So what happens if a mistrial is called?

[Andrea Dunlop]

We start all over. I mean, both sides have to retool and ramp up. I've been involved in those. And essentially what happens is this, whatever how many weeks we've been doing this becomes a kind of very elaborate mock trial for the real one that comes later. It's hard to imagine, but it all would cure up at some future date.

[Dr. Bex]

Oof okay, so to recap, there are a total of five doctors who've testified on Maya's behalf. You have Dr. Kirkpatrick, Dr. Chopra, Dr. Cantu, who is the doctor who provided the ketamine coma treatment in Mexico, as well as Dr. Wassener, her pediatrician, and Dr. Spiegel, who is a neurologist who prescribed Maya these hyperbaric oxygen tank treatments that she was receiving at the same time that she was getting the high dose ketamine infusions. And of course, there is Dr. Hannah, who is the doctor who provided the ketamine, given that he saw Maya 55 times in the year leading up to her Johns Hopkins stay, and was the doctor who referred her to Johns Hopkins for her stomach pain. His absence at this trial has been notable. However, he did give a deposition which the defense played in court. That is, Johns Hopkins played this in court. And honestly, as soon as they did, I could see why maybe the plaintiff didn't call him. His deposition was a little all over the place. But he did say that he had maxed out the dosage he was willing to give Maya. And just as a reminder, this dosage is, as we've heard from various doctors throughout the trial, 25 to 50 times higher than any ketamine dosage they've ever seen. And Dr. Hanna also said that was his ceiling and he couldn't do any more for this child at that time. Two of the doctors who have done a full medical record review for this case and have testified for the defense also said that Dr. Hannah's monitoring at his clinic was substandard, to say the least. Now, of the more than three dozen doctors who evaluated Maya during this time period, several other doctors with expertise in CRPs and pediatric pain did not think that her systems were at all consistent with CRPS. The first one we heard from was a Dr. Gaddy Revivo, who works with a pain clinic that works closely with Lori Childrends, where Maya spent some time. So this is a piece of his testimony from law and crime networks coverage.

[Jonathan Leach]

Let's go back with your note here.

[Andrea Dunlop]

You know, it says. You see where it says, today Maya is in pain. Do you see that? Yes.

[Jonathan Leach]

Okay.

[Andrea Dunlop]

And then it says, quote, she describes the pain as constant and involving her entire body, including legs, back, head, and arms. Do you see that? I do. Is that the type of pain presentation that you would typically associate with the patient with pediatric complex regional pain syndrome? No.

[Jonathan Leach]

And why is that?

[Andrea Dunlop]

For the very nature of the definition. It's complex, but it's regional. So typically, we'll see patients who present with a limb, so maybe a foot or a leg. I have seen patients that may present with a kind of hemiparesis presentation, so they'll present with a limb and the trunk. But this is. This is a different diagnosis based on what we're saying here. Based on my experience, the second person.

[Dr. Bex]

We heard from was Dr. Elliott, who is the anesthesiologist from Johns Hopkins. He testified on October 23rd there would.

[Jonathan Leach]

Be times where I would see Maya with anklets on her ankles, but if.

[Andrea Dunlop]

Someone would attempt to touch her leg.

[Jonathan Leach]

Lightly, then she would complain of pain.

[Dr. Bex]

Just very much inconsistent with.

[Jonathan Leach]

The diagnosis of crps.

[Dr. Bex]

So does Maya have CRPS or not? We will never know for sure, but given what we do know, I think most likely she does not. Of all of the medical professionals who may or may not have been qualified to diagnose CRPs, Biotta, smart as she was, was not one of them. And this diagnosis appears to have originated with her. It's worth mentioning that the defense team is not moving on the assumption that she didn't have crps, partly because the treatment for CRPS and conversion disorder, which is what they believe she did have, is the same. Here's Dr. Elliott explaining this. And this clip is from Law and Crime Network. Well, as I shared, the standard of.

[Andrea Dunlop]

Care for pediatric CRPs is really functional.

[Jonathan Leach]

Restoration, meaning that you engage the patient in the endeavors of physical therapy, occupational therapy, and cognitive behavioral therapy.

[Andrea Dunlop]

The medicines are really used to facilitate.

[Jonathan Leach]

Those things, not for anything else.

[Dr. Bex]

You know, I really sense how careful the majority of the doctors on the defense side are. They're really avoiding inflammatory language. They seem to be taking pains not to speak ill of Biota or Maya. There was one doctor, however, who did not dance around his conclusion. We heard a piece of his affidavit in our episode about Beata's death. So this is Dr. Elliot Crane from Stanford, and this clip is from the Law and Crime Network's coverage.

[Andrea Dunlop]

Where do you presently practice, your profession? Actually, I retired on May 1. But prior to that, Stanford University in the School of Medicine. Okay, and you retired, when was it? May 1st. May 1st. Okay. And tell us, if you would, please, sir, where you received your background, where your education and training to become a physician. I went to medical school at the University of Arizona in Tucson, Arizona, graduating in 1977. From there, I did pediatric residency at the Massachusetts General Hospital in Boston. Following that, an anesthesiology residency at the same hospital, and then a fellowship in pediatric anesthesia and critical care Medicine at Boston Children's Hospital. That was all finishing at the end of 1983. Are those programs at Massachusetts General and Boston Children's affiliated with Harvard? Yes, they are.

[Dr. Bex]

So there was so much to Dr. Crane's testimony. But just to kind of share some of the highlights, what I found most interesting about his testimony, you know, he talked about the fact that there are actually uses for ketamine that are legitimate with childhood CRPs in cases where a child has refractory pain. So that's pain that has been resistant to any other kinds of treatments. However, he did say that if you're doing something like a ketamine infusion, number one, he uses a very low dose, so 1 25th of what Dr. Hannah was ultimately using on Maya, and that this kind of treatment should be done only in a hospital setting where there's proper monitoring. He also described ketamine withdrawals. And as he was talking through this part, this was really fascinating because the plaintiff has talked about ketamine as though it's kind of no big deal. Like, that this was a perfectly, you know, safe medication that there was no side effects from. And hearing him talk about ketamine withdrawals and then looking at some of Maya's behaviors when she arrived at the hospital where she was demanding anesthesia and really acting out like she was swearing at people, she was yelling. It really sounded similar to what he was describing when he talked about ketamine withdrawals. And that description really got me. He also offered his expert opinion in why Maya does not have CRPs and talked about some of her alleged symptoms, some of which were shown in photos by the plaintiff's side of, quote, lesions, which he agreed with Dr. Revivo, that the legion they showed was a scratch. And Maya's alleged dystonia. Now, dystonia is something that has come up a lot came up in the film. It came up in the court case. And he explained that dystonia, basically, and this was one of my questions throughout this dystonia does not come and go, like during the course of a day. So if Maya had dystonia in her feet, they would be frozen in that position for a period of time. They wouldn't be dystonic. And then in the anatomically correct position on and off throughout the day, which is what all of these providers have observed about her. He also looked at this photo of Maya when she was in a coma in Mexico that was. Was taken by biota with her feet turned in. This was used as evidence that she was not faking this dystonia that she really had her feet frozen in this position. But Dr. Crane explained that when children are under anesthesia, their feet either splay out or turn in, and hers turned in. So that's just what kids feet look like when they're under anesthesia. They also asked him the question of whether he had found with his patients. And again, you know, he ran this pain clinic that was the only one of its kind on the west coast. So he really was a destination for parents whose children had CRPs. He said they would come from all over the world to see him. And they asked him if he had seen the same pattern that Dr. Hannah, Dr. Kirkpatrick and Dr. Chopra had reported, that they had all said that they are always seeing their parents of CRPS children being falsely accused of Munchausen by proxy. They asked him about this and he said, absolutely not, no connection. So to my mind, that tells us something about the clientele for those other Doctors, not about CRPS parents. And Dr. Crane really painted a very different picture of the prognosis for childhood CRPs than the experts who had testified for the plaintiff. In particular, Dr. Chopra, who really painted this picture of, you know, this being a lifelong condition where Maya was always going to be in horrific pain. And obviously part of the thing that they're asking for in the estate damages question is money for ketamine to treat Maya's condition, money for the full time care that she might eventually need. So Here is what Dr. Crane said about the prognosis for childhood CRPs and his experience. This is from Law and Crime Network's coverage.

[Andrea Dunlop]

Maya, I think was about 10 years old at the time. And I would say that 10 year old girls, and I say girls because it's about seven or eight times more common in females than in males. Almost all of our patients are females who have CRPs. We don't know why that is, but 10 year old girls with CRPs are our favorite population to take care of with CRPs. Why? Because they're the easiest to take care of, they recover the fastest and they don't recur. Of all the kids we've taken care of, we've never had a recurrence of CRPs in a child whom we've treated at the age of 10 or 11 or 12. As kids get older, it becomes more difficult to treat, more challenging. And as children advance through adolescence, their teen years into their young adult years, it begins more and more to take on the pattern of adult CRPs, which is a much more difficult condition to treat.

[Dr. Bex]

All in all, we've heard from About a dozen medical professionals who've testified on behalf of the defense so far. And considering that these people are from numerous different institutions, they paint a remarkably consistent picture of Maya. They said that she was distractible from her pain, that is, that she would be screaming in pain one moment, but that she could answer questions if you asked her. They said that she showed much more functionality than she reported. So if you'd ask her, for instance, if she could move her hands, she would say no. But then if you would observe her while she wasn't being asked, they would see her moving her hands, and they've reported that she had no physiological signs of pain. The other consistent thing that we've heard from this provider is that Biota's presence had a negative effect on both Maya's perception of her pain and her behavior. So what do you do when you have all of these doctors who are disagreeing with each other and they have had varying levels of communication with one another? Mostly they've had no communication with each other. So what do you do if there's a suspicion of abuse in this case? Ideally, you would bring in an experienced child abuse pediatrician to look at the whole picture, which is exactly what happened. And on October 26, we finally heard from the woman who's been blamed by the Kowalski team for just about everything. This is a clip from the Netflix film Take Care of Maya. This young girl, Maya, represents hope for all of us in bringing Sally Smith down, bringing the system down. Dr. Sally Smith arrived in the courtroom, and when she took the stand, she went about pulling these enormous binders out of her bag and stacking them next to her mic. Unlike Dr. Kirkpatrick, who famously left his notes in the hotel room, it would appear that Sally Smith did not. So she looked a bit shaken up to begin with. And this is unsurprising since I've heard numerous reports of protesters being outside, one of whom apparently confronted her right before she came in. Listening to Dr. Sally Smith describe what she does in her role as the head of the cpt. So that's child protection team was really fascinating, and it really drove home for me what a difficult job this is. You know, she is looking day after day at the worst part of humanity. She's looking at people who've done horrible things, potentially, to their children. And, you know, also, I think the thing that never comes up is that she's looked at over 3,000 cases in her career, by her estimation, and. And many of those were probably not abuse, and she helped those parents not have to go through a DCF investigation. And that's just something that never gets talked about because those parents might not even have known that she was looking at their records. So anyway, it was very satisfying to watch her shut down one by one, these claims that have been made about her in this case. So this is Jack describing his interaction with her in the Netflix film.

[Andrea Dunlop]

She never stated who she was. She just walked in, looked at me, looked at Maya.

[Dr. Bex]

She came in and she acted like a regular doctor that worked for the hospital.

[Andrea Dunlop]

And she started to ask questions.

[Dr. Bex]

If they would have known who she was, we would have never spoken to her. Here is Dr. Smith describing the meeting that actually took place. And this is from Lawn Crime Network's coverage.

[Andrea Dunlop]

Did you ever interview Mr. Or Mrs. Kowalski?

[Jonathan Leach]

I took as part of my medical evaluation. I took a fairly extensive history from Mrs. Kowalski and a much more abbreviated history from Mr. Kowalski. The meeting with Mrs. Kowalski took place on October 11, 2016, and the relatively brief interview or history taking with Mr. Kwaski occurred on October 3.

[Andrea Dunlop]

Did you ever speak to the two of them together?

[Jonathan Leach]

I did not.

[Andrea Dunlop]

When you spoke with Mrs. Kowalski, first.

[Dr. Bex]

Of all, where was it?

[Jonathan Leach]

So at that time, Maya was still in the pediatric icu. They have a like a family conference room kind of thing outside of the main entrance to the pediatric icu. And because of the investigation that was being initiated and everything, I scheduled a time where the child protective investigators and the people in law enforcement that were investigating the case could join me while I took my medical history. So as I recall, There were about five of those people, two or three child protective investigators, I think two law enforcement people, and Mrs. Kowalski. They were all in that room already when I got there for the scheduled meeting, which I believe began at 5:45 in the evening on the 11th. Did you identify yourself to Mrs. Kowalski? Absolutely. What?

[Andrea Dunlop]

How did you identify yourself?

[Jonathan Leach]

I always say, I'm Dr. Sally Smith. I'm a pediatrician with the child protection team, and that's what I said to her.

[Dr. Bex]

So, interestingly, the meeting with Jack appears to have happened after she took the history from Biota, which we know that Biota told Jack about because there was an email to that effect. So it doesn't really seem plausible to me that Jack didn't know who she was. But, you know, under those circumstances, he's stressed out. I could see why he might mistake her for a doctor that worked for the hospital. He wouldn't have necessarily known what she looked like. But at the same time, I've never been clear on what Jack thinks would have been different if he hadn't talked to Dr. Sally Smith. Anyway, there was a lot of back and forth about whether Dr. Sally Smith was in any way a treating physician and she said that she did have ongoing conversations with the doctors but did not do anything like making orders or see a Meyer in rounds or anything like that. So listen, my overall takeaway on this point is that maybe there is some murkiness around cpt, dcf, Department of Health and the doctors in this case, but that is a systems problem, not a Dr. Sally Smith problem. So she also shut down that HIPAA claim and she cited a specific exception to it. Doctors who are performing her role can look at records. If someone has a concern about abuse, which is what happened in this case, some of the most compelling moments happened during Gregory Anderson, that is again the lead attorney for the Kowalski's cross on the proffer. So the proffer, I am not a lawyer but in my understanding this is a place where they are collecting evidence that the jury does not see but that may be used in the appeals process or is being collected for the record. So the jury was not in the room when some of these things were being said sadly. So right away they addressed one of the biggest criticisms about Dr. Smith that she did not take Dr. Kirkpatrick seriously enough here Gregory Anderson asks Dr. Sally Smith about this. This audio is from the Law and Crime Network.

[Andrea Dunlop]

Yeah, except for the fact that you did not tell anyone in that report that he had warned you off of going after the Kowalski's.

[Jonathan Leach]

That's it's completely irrelevant for a child protection team medical evaluation because that's the whole point of the, of the evaluation, gathering all the records. 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 the ketamine coma told me not to investigate child abuse was completely irrelevant to me because my job was to investigate child abuse. So if I had come away from my job saying I was supposed to do this, but this doctor told me not to, so I'm not doing it and there's no evidence of anything here, I would not have been doing my job even remotely near a standard of care.

[Andrea Dunlop]

Do you not understand the importance of putting both sides of the story in your report?

[Jonathan Leach]

The both sides of the story is the responsibility of the various people who are going to present it to the court. My job as the medical director for the child protection team is to do what I need to do to assist the investigators and the detectives and the attorneys that are involved in the case as to whether there is evidence to support a diagnosis of whatever type of child abuse is being assessed. So it's not my responsibility to lay out some whole long argument about what it might be otherwise if I have extensive evidence to support that it's a type of child abuse.

[Dr. Bex]

She also finally addressed something that has been driving me nuts, and this is the conflagration between factitious disorder imposed on another and medical child abuse.

[Jonathan Leach]

Medical child abuse is a child abuse pediatric diagnosis. There is a parallel track in psychiatry where there's a thing called factitious disorder imposed on another, 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'm very well trained to evaluate medical child abuse based on my child abuse pediatrics experience and board certification.

[Dr. Bex]

Interestingly, Anderson also lied to her during this back and forth. He said that there were no other doctors who testified and said that Maya didn't have CRPs. And that was wild to hear him say because we have just watched a number of extremely qualified doctors do exactly that. So Dr. Sally Smith was very clear on two points, that she was the person in the situation most qualified to diagnose medical child abuse, and that there was very clear evidence of it in this case. And she addressed these other providers who've been brought by the plaintiff, the folks who supported the CRPS diagnosis.

[Andrea Dunlop]

Dr. Hannah, a anesthesiologist with over 25 years of experience in treating CRPS. You didn't put his confirmation or, excuse me, he did a diagnosis of CRPS in your report either, did you?

[Jonathan Leach]

I believe in the history I made reference to that. Yeah, I'm pretty sure I did say that, that he, you know, made that diagnosis. But this is a doctor who was giving a child, a 10 year old child, who's on the small side, 1,000 milligrams of ketamine, anywhere between 8 and 32 milligrams of Versed doses of Zofran, 17, 50 milligrams typically of magnesium, all at the same time in an outpatient setting with no documentation of medical, of vital signs. And there was indication in the records that appeared to me to suggest that the family member was the person monitoring the pulse oximeter. So that person, to me, is not particularly reliable in terms of whether this child needed the treatment that she was getting, whether he made an accurate diagnosis or not. So I put his information in my report. Yes, I discounted his diagnosis.

[Andrea Dunlop]

And of course you discounted Dr. Cantu's confirmation of CRPs.

[Jonathan Leach]

Well, I never got any records from Dr. Cantu so I couldn't really address that whole situation other than from the WordPress blog. This person put a 9 year old child in a ketamine coma for days. It took her probably about a week to just be able to be discharged from hospital after that. So I didn't find him reliable from what I saw.

[Dr. Bex]

And then there was this memorable exchange.

[Andrea Dunlop]

Well, isn't it true ma' am, that.

[Jonathan Leach]

You are not a medical investigator, you.

[Andrea Dunlop]

Are in fact a medical prosecutor?

[Jonathan Leach]

That's absolute nonsense.

[Dr. Bex]

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[Andrea Dunlop]

The visuals that I have seen, I'm not sure are that helpful to the plaintiff. That is my sort of windshield take on a lot of these photos, video. Even seeing this young lady in the courtroom, I think as a juror, maybe I'm a little puzzled by how serious was this. How ill was she? And I'm thinking, for example, maybe of photos or videos that took place in Dr. Kirkpatrick's office, where she seems to be almost bubbly and engaging with him in light and seemingly happy way at a time when I think we are told that she is in terrible pain. So the fact that the jury has been exposed to things like that makes me maybe a little, if I'm the plaintiff, maybe a little concerned about what the takeaway is from all that.

[Dr. Bex]

Yeah, the visuals of Maya. And I watched the bulk of that video that's on director Kirkpatrick's website, which is. That's one of the things he does, is his research is videotapes these sessions with clients. And, yeah, it's hard to sort of conceive of how that's a child in excruciating pain. And indeed, even the footage of her from Johns Hopkins that they included in the Netflix film, she looks bored. I mean, she doesn't look like she's in excruciating pain. And, of course, that lines up with all of the reports from the doctors during that admission and several others before it. And I think it's. You know, it's really interesting to think about the visual of Maya herself sitting in the courtroom, because I think on the one hand, you know, she's this beautiful, sad young girl. I think that has its sort of cultural power all its own. But then she's looked a bit unwell to me the last few days, and I worry very much about the toll that this is taking on her and her brother. But, I mean, in general, she looks healthy and she's clearly walking around. And I think that the plaintiff is trying to make this case that, you know, specifically in terms of the medical malpractice claim, that the treatment that she received during her stay at Johns Hopkins actually set her back, when, in fact, she was never given ketamine again, you know, after a little bit that they gave her in the. In the picu, and then she's never received ketamine treatment since. And the overall trajectory of her health has been. Has improved a hundredfold since that time before the hospital where she was confined to a wheelchair out of school, going to these ketamine treatments every week, getting all this hyperbaric oxygen things, and just really in doctor's appointments all the time.

[Andrea Dunlop]

Right. I want to touch on another example of a visual that I think would be very helpful on a horizontal timeline. You know, if one entry is her treatment at Tampa General, which is basically the month of July and August in 2015. As I understand it, Andrea, she is prescribed physical therapy and psychological counseling coming out of Tampa General. As far as I can tell, the really next significant event after that visit to Tampa General, that month there of therapy is that Beata takes her to Dr. Kirkpatrick for what begins this ketamine infusion treatment. I mean, it just in terms of a visual that just seems to be a significant turn that would be important for the jury to know about.

[Dr. Bex]

It's hard to remember sometimes that it's actually the hospital that's on trial rather than Biota Kowalski, because of course, whether or not she'd been committing medical child abuse colors and absolutely everything about this case. A few days into the defense, the judge issued an order that really restricted how much the defense could talk about Munchausen by proxy and medical child abuse going forward. Though, of course, the plaintiff had had witness after witness on the stand talking about, quote, false allegations, despite that count being dismissed already. And they made the argument over and over again that this wasn't Munchausen by proxy, this was crps, as though those two things are mutually exclusive. And of course, there's also the fact that they don't seem to believe that Munchausen by proxy is even real. So we had talked about this Dobert motion earlier on, and here is Jonathan breaking that down with us.

[Andrea Dunlop]

In essence, it says that the specialized knowledge that the expert has is admissible if it is based on reliable principles and methods that are generally accepted in the community of experts, typically the scientific community, and that it's based upon facts and data. And that in the judge's opinion, the expert has reasonably rationally applied the principles and methods to the facts and the data. And what the plaintiffs in this case are asserting is that because these terms, Munchausens and falsification, medical child abuse are so fuzzy in their opinion, and the science is what they characterize it in their motion as junk science, that Judge Carroll should not allow any of this testimony in.

[Dr. Bex]

It'S really hard not to feel Beata's presence looming in the script courtroom. It's the central question that most people are duking it out about online. You know, was she a martyr or a monster? Technically, of course, it doesn't matter for these specific counts, but also it deeply does. Depending on which side of the dichotomy you fall, you either think Johns Hopkins was being rightfully protective of Maya or senselessly cruel to Biata. And this also colors the view of Beata's death. Was she an innocent mom who believed that ending her own life might save her daughter? Or or was she an abuser who feared that her lies were about to be exposed? We've heard snippets of her throughout the trial, from doctor's notes, from recordings, and from the notes she left behind upon her death. But this week we got a much more intimate and disturbing look into Biota's mind via a number of emails that she had written to herself. These were drafts, they believe, of the blog that she maintained that was written in Maya's voice. These letters chronicle the ketamine coma that Maya underwent in November of 2015, which the plaintiff has taken great pains to paint as not so terribly serious of a procedure. So we are going to have my producer Tina read us a bit from these letters. This is from the first batch.

[D]

Unfortunately things got complicated on Tuesday 11 17. My blood work came back bad. Potassium, magnesium, protein levels and HGB were low and the worst of all my cortisol level was zero. I was back in adrenal insufficiency. That was really the worst possible news I could receive this morning. Due to high risk for complications from adrenal insufficiency including death, my ketamine coma got postponed for another day. I had to be re evaluated by Pete's ICU doctor who then consulted Peds Endocrinology for more brain knowledge. This disease is very rare and especially more rare in children so there are still many unknown phenomena. The doctors are still learning more about RSD each day from each RSD case they get. My case will help other RSD patients in the future and the hope is that maybe one day the FDA will approve ketamine coma in the us. It is really sad for American citizen to go out of the country in Mexico to receive this type of treatment. So far I am the youngest child in history who has developed severe generalized RSD in very short period of time and I am the first youngest child in history who is going to be placed in high dose ketamine coma. It's my last and only chance for better quality of life. Getting rid of pain, dystonia, allodynia and maybe a chance for being Able to stand or walk one day. Again, this procedure is very high risk in my complex case due to the fact that I have immunodeficiency and very poor nutritious status and now very severe adrenal insufficiency. I was told today I am high risk patient for developing infection, sepsis during the coma, difficulty weaning off the ventilator after coma, needing blood transfusions and a total body failure, death as a result of adrenal insufficiency and other complications. Despite the risks and complications, there are several good things going for me right now. My young age, very early RSD, crps, diagnosis, hundreds of angels watching over me, and God working through the doctor's hands and brains to get me a remission. I am hoping for a miracle. Ketamine coma, exclamation point, smiley face.

[Dr. Bex]

So this is the procedure that the plaintiff has painted as being of no real risk to Maya. And this business about the child being the youngest, most rare, most unique pediatric case of something to have ever existed, this is a huge red flag. There are so many parallels in this to the Mary Welch case, which was the case, if you'll remember, that we discussed in season one. So in this, her son had allegedly this extremely rare condition. In his case, it was something called normal pressure hydrocephalus, which is a condition where fluid builds up on the brain. And Mary also talked to friends about how the medical community was learning so much from his case. She also insisted that he needed the most invasive treatment, a brain shunt, in his case, despite the fact that many doctors told her that he did not need it. And the only doctors that Mary trusted were the ones who gave her what she wanted. So I have been watching the online conversations about this case and there was a huge shift once these letters became public. Many people were horrified by these. Obviously the procedure itself and just the number of heavy duty medications Maya was on is harrowing to read about. Then there's the fact that she is writing this blog in Maya's voice, which seemed pretty off to a lot of people. And I don't know how else to describe the tone of these letters other than cheerful. So here is my producer, Tina, reading from another one of these letters.

[D]

Last night was really rough for me. My temp went up again. I became more tachycardic and restless. The sputum gram stain came positive. So they're going to continue IV antibiotics despite continuous high doses of Ketamine, Versed and Precedent iv, plus extra doses of Ketamine, Versed, propofol. I was still waking up at night every 20 to 30 minutes. I was very restless all night and managed to tongue out about 3 inches of OGT. Ketamine gives me magical powers, and I acted like I was a Supergirl. Today is coma day three. Yay. I feel better today. After Dr. Cantu increased my ketamine infusion to 2.5mg per kg per hour. He also increased my Versed drip to 4ml per hour Precedix to 3.8ml per hour. He was also kind enough to increase the ketamine extra boluses to every one hour on top of bursed boluses and propofol boluses. I have very high tolerance for drugs. If I was a horse, I would be comatose or dead already. But things are totally different when it comes to a girl with rsd. My metabolism is super fast. My mommy says I'm not a cheap date, and my daddy's response was that he feels deeply sorry for the lucky man that will marry me one day. Smiley face.

[Dr. Bex]

Throughout the plaintiff's arguments, there was a lot of talk about how safe ketamine is, how it has no withdrawal symptoms, how these treatments never really put Maya in any danger, and how Maya was, as one of the plaintiff witnesses testified, a, quote, freight train headed to college before Johns Hopkins permanently injured her by taking her off of the ketamine, which she has remained off ever since. The plaintiff has also framed this ketamine coma similarly. It didn't really have a 50% chance of death. That was just the warning that Dr. Cantu had to give the parent for some reason. But reading Beata's accounts of these five days was chilling. To picture her typing these out as she sat at her daughter's bedside, it just sticks with you. These letters also fit in with the overall picture that Beata seemed to be painting of her daughter's condition in her request to have her labeled as terminal, in her multiple mentions of hospice and, quote, wanting to go to heaven, and even in her ending note, take care of Maya, but don't let her suffer. No child deserves that. She was not depicting a freight train headed to college, but a freight train headed off a cliff. Whatever you think about her, there's no holding Biota to account now. It's everyone else who's left behind who has to pay the price. And that goes far beyond Johns Hopkins and the Kowalski family. The verdict in this case could be days away at this point, so likely the next episode that you will hear will be about that verdict. We're also going to talk in a coming episode much more about Maya Kowalski's testimony, because however this verdict plays out, this has really defined her young life. And it will have reverberations for the rest of it. That's next time on Nobody Should Believe Me. Nobody Should Believe Me is a production of Large Media. Our senior producer is Tina Knoll, and our editor is Karine Kiltow.