'Take Care of Maya' trial: Dr. Sally Smith testifies, as hospital cites 'chilling effect'

The legal defense for Johns Hopkins All Children's Hospital is standing behind mandatory child abuse reporters due to what they call a "chilling effect" following a lawsuit from a Venice family.

Ethen Shapiro, one of the hospital's attorneys, said the case is an opportunity for the hospital to show support for its staff and prove that the totality of the care provided to Maya, and any patient, is that of compassion.

"The reason why All Children's decided to take this case to trial was because, unfortunately, this case has caused a deep chilling effect on mandatory reporting throughout the country," Shapiro said. "And All Children's is here standing up for mandatory reporters that when we suspect child abuse, we report it."

Shapiro told reporters the hospital is finally able to get its side of the story out to the public after the family's side dominated previous media coverage and the recent release of the Netflix film, "Take Care of Maya."

Keep reading: Defense witnesses continue to question Maya's CRPS diagnosis

'My life is a lie': All Children's doctors, nurses testify in 'Take Care of Maya' trial

The Kowalski family say that the hospital's actions, and that of the staff, led to Beata Kowalski's taking her own life in January 2017 after allegations of child abuse against her opened a Department of Children and Families investigation and a court order separating her from 10-year-old Maya Kowalski for more than three months.

The Kowalski family sued All Children’s Hospital in 2018 for $220 million more than a year after the family matriarch, Beata Kowalski, took her life following allegations she was abusing her daughter.

The family took 10-year-old Maya Kowalski to All Children’s Hospital in October 2016 after she complained of severe stomach pain, believed by the family to be a relapse of her Complex Regional Pain Syndrome, a disorder that impairs the central nervous system and heightens pain sensations.

Staff at the hospital began to suspect that Maya may not have had CRPS after they noticed inconsistencies, as well as what has been described as "erratic" behavior from the child, and that Beata seemed aggressive with staff, according to defense witness testimony.

Dr. Sally Smith takes the stand, clarifies her role in case

The former part-time medical director of the Child Protection Team for Pinellas County appeared in court Thursday to clarify her involvement in Maya Kowalski’s case. She said that while she worked for All Children's Hospital, she left in 2002 and never worked there when the hospital was integrated into the Johns Hopkins health system.

Dr. Sally Smith had an integral part in the Venice family’s case against the St. Petersburg-based hospital following her involvement in investigating Beata Kowalski after the allegations of child abuse were called in through the hotline earlier during Maya's admission.

Smith was originally a part of the lawsuit, as well as her employer Suncoast Inc., however, the two settled with the Kowalski family for $2.5 million, according to media reports.

Smith first received a call on Oct. 8, 2016, about Maya's situation from Dr. Beatriz Teppa-Sanchez, who was reaching out to consult with an expert to see if this was a potential case of child abuse. Two days later, Smith received a second call about the 10-year-old and opened a formal investigation as part of the child protection team.

Howard Hunter, defense attorney for Johns Hopkins All Children’s Hospital, questioned how Smith had introduced herself to the Kowalskis for the first time. Smith first met with Beata Kowalski on Oct. 11, when she scheduled an interview in a small family conference room. When she arrived, she found Beata in the room along with four to five law enforcement officers and child protection investigators, and their conversation lasted an hour and a half.

Smith met Jack Kowalski two days later when she stopped by Maya's hospital room and ended up speaking with him for 10-15 minutes.

In both instances, Smith testified that she was wearing business professional clothing, no lab coat, and a badge with her name and introduced herself to the Kowalskis as a pediatrician working with the child protection team.

Smith's testimony contrasted that of both Jack and Maya Kowalski who said Smith entered the room wearing a white lab coat with the hospital's logo and hadn't introduced herself before launching into questioning Jack.

When asked about her involvement in Maya's medical care, Smith testified that she only communicated with hospital staff when it was relevant to the DCF investigation and that the text she sent to one of the doctors caring for Maya was along those lines. Smith added the same was true for lab tests she'd requested for Maya from doctors.

When Greg Anderson, the family's attorney, pressed Smith during cross-examination about her involvement in Maya's treatment care plan during her DCF investigation, Smith at first stood by her statement that she wasn't involved in Maya's treatment plan, despite her name being mentioned in several hospital notes as sitting in on meetings about Maya's care.

"So, were you part of the treatment or not?" Anderson asked.

"I guess it's sort of threading the needle," Smith said. "I wasn't writing any orders, I didn't tell them which medications to stop or wean or anything like that, but as part of the whole evaluation of medical child abuse there's a component of what happens when they're not getting all these medications, so that specific little part of it was within in my role."

During a proffer outside the presence of the jury, Smith said that not all neurologists and anesthesiologists are created equal, referring to Dr. Anthony Kirkpatrick, Dr. Ashraf Hanna, and Dr. Allan Spiegel, and she didn't find the information that was provided to her to be reliable after looking at research by other experts. Although she said she included their opinions in her report.

When Anderson pressed Smith on whether she knew more about CRPS than three anesthesiologists specializing in pain management and CRPS, Smith said she didn't, but she again stated she didn't find their opinions reliable.

Smith said she dismissed Kirkpatrick's urges to not pursue investigating claims of Munchausen Syndrome by Proxy because her job was to investigate child abuse, she said, adding it's not her job to present both sides of the story as that falls to the attorneys.

She said her job was to review Maya's medical records, of which she inspected more than 2,000 pages of files, and to speak with physicians, nurses, and others involved in Maya's care, as well as to consult experts to come to a conclusion in her report, which stated “positive findings of medical child abuse” and Munchausen Syndrome by proxy.

Smith further argued she has extensive knowledge of medical abuse and neglect, adding there is a parallel track in psychiatry with factitious disorder, but she doesn't need a psychiatry degree to investigate child abuse.

"That's absolutely nonsense," Smith said when Anderson inferred in one of his questions that she was not an investigator, but rather a prosecutor.

"I'm neither," Smith said. "I'm a medical doctor, who's an expert in child abuse pediatrics."

'Take Care of Maya' trial: Kowalskis testify about personal, economic impact for damages

Keep reading: Case worker contests identity of voice in audio clips in 'Take Care of Maya' trial

Hospital nurse shares how Maya was treated

Nurses braiding 10-year-old Maya Kowalski's hair, staff bringing in new nail polish for "spa days," Maya asked to judge a cookie baking contest among nurses on the seventh floor for Christmas, and a nurse taking home Maya's clothes to wash so she has fresh options.

That's how one nurse, Lisa Rek, described Maya Kowalski's stay at Johns Hopkins All Children's Hospital.

Rek was not the first hospital staffer the defense has called to testify about Maya — painting a stark contrast to what Maya, her father, and other witnesses described her time at the hospital to be like when attorneys for the family were presenting their side of the case.

Since Maya was in the hospital for so long and Rek was both her bedside nurse and the charge nurse for the unit where Maya was staying, Rek said she was able to get to know Maya well.

Rek recalled trying to keep a morning routine for Maya to help her have some normalcy. Rek would come in the morning, and help Maya to the bathroom to brush her teeth and use the toilet, and Rek would then lay out Maya's clothing so she could choose her outfit. She added that Maya was a very modest child, so Rek would close the door and blinds, and hold up a blanket so Maya could change in privacy.

Over her stay at the hospital, Maya accumulated a lot of items in the rooms Maya stayed in, which Rek described as having two TVs, colorful, pastel walls, and a big window. Some of the items Maya had in her room included arts and crafts, stuffed animals and toys, and blankets. Rek added that Maya spent plenty of time outside her room participating in activities.

When asked if Maya appreciated the nurses' efforts, Rek said Maya at one point had baked cupcakes during an afternoon activity and handed them out to a few nurses. Rek took this as a sign that Maya was showing appreciation. Rek also read an application Maya had filled out for another nurse for an award, which was submitted as evidence for the jury to review.

Anderson questioned Rek about the situation where Maya was forced to have photos taken of her body, while she was only wearing a training bra and shorts, prior to being able to go to a court hearing in January 2017. When Greg Anderson asked if she found it offensive to strip a child down and force photos, Rek said she couldn't comment because she wasn't a part of that situation.

All Children's Hospital physical therapist says Maya improved

When Maya Kowalski entered Johns Hopkins All Children's Hospital, she had chronic pain, abnormality in gait and mobility, abnormal posture, and weakness, according to records and testimony presented to the jury.

In a note dated towards the end of Maya's stay, the same conditions were noted as being present.

Surveillance video from the room where Maya was monitored for 48 hours also showed that she required full assistance moving from her bed to her wheelchair, and once in the chair, she seemed to be weak — giving her physical therapist, William Siesel, a light high-five.

Siesel said Maya had improved in three areas: her sitting balance, or being able to sit independently without assistance in her wheelchair and participate in activities; her posture, which went from being slumped to upright with no visual or verbal complaints of pain; and her activity tolerance going from being able to sit and participate in activities from a minute or two to a full therapy session of 60 minutes or more.

“She displays the functional strength to complete tasks,” one of Siesel’s notes stated.

Siesel remembered that Maya was an easy patient to get along with and that during her first sessions with him, she tried her best and attempted many of the movements that were asked of her, even attempting to stand up.

However, in later sessions, Maya pushed back, refusing to do certain activities.

Emotional testimony: Maya Kowalski testifies about hospital experience

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“This treatment isn’t going to work. Physical therapy isn’t the treatment I need. I only need ketamine, that’s the only thing that’s going to work for me,” Siesel recalled Maya telling him when he tried to educate her on physical therapy.

When Anderson asked Siesel if he’d known Maya had gone through intensive physical therapy for a month at Tampa General Hospital between July and August 2015 and it hadn’t helped her, Siesel said he hadn’t been aware.

Siesel also pointed out several inconsistencies with Maya that he’d observed, including that she was able to wear leggings or sit crisscross without complaint of pain, but then a slight touch to her leg would cause excruciating pain; and that Maya would be able to do certain movements while distracted by playing a game or an activity, but when Siesel would ask her to replicate the same movement consciously, Maya said she couldn’t.

In contrast, Anderson said that one thing that was consistent was Maya’s complaints of pain and Maya not being able to put weight on her feet so she could walk. When Anderson tried to state that Maya also had dystonia the entire time, Siesel said he hadn’t observed dystonia in the 10-year-old, but rather her feet were in a slacked downward position.

“I never give up on any of my patients,” Siesel said.

“My goal the first time I saw her was to help her get better,” he added. “I wanted her to leave our hospital walking. I wanted her to be there walking, be able to go back to school, walk around school, do the activities she wanted to do ... We got into the profession because we like helping kids get better.”

Gabriela Szymanowska covers the legal system for the Herald-Tribune in partnership with Report for America. You can support her work with a tax-deductible donation to Report for America. Contact Gabriela Szymanowska at gszymanowska@gannett.com, or on Twitter.

This article originally appeared on Sarasota Herald-Tribune: 'Take Care of Maya' trial: Former DCF investigator testifies