VENICE, Fla. - Jurors returned to a Sarasota courtroom on Thursday in the $220 million case against Johns Hopkins All Children’s Hospital that was the premise of the Netflix documentary ‘Take Care of Maya’.
They had the day off on Wednesday while lawyers and the judge met to discuss motions and jury instructions.
On Thursday morning, Johns Hopkins All Children’s Hospital critical care physician Dr. Beatriz Teppa-Sanchez took the stand.
She testified that there was a lot of chaos when Maya arrived in the pediatric intensive care unit. She added that Maya was screaming in pain and her mother, Beata Kowalski, was also yelling, telling medical staff they needed to listen to her.
Dr. Teppa-Sanchez stated that she believed Maya was clearly suffering at that time and recalled that she was given a sedative to calm down.
The doctor said that Maya told nurses she needed her anesthesia medicine, and she needed them to push the medication.
"She was suffering," Dr. Teppa-Sanchez told the jury. "She was clearly suffering."
However, the doctor added that it wasn’t clear what was causing the pain.
Dr. Beatriz Teppa-Sanchez testifies in 'Take Care of Maya' trial.
Dr. Teppa-Sanchez said the hospital did administer a lower-dose of ketamine than Beata Kowalski requested for her daughter.
She noted that Beata Kowalski said she had been very stressed and at times wanted to die and just go to heaven. The doctor added that Beata Kowalski said that when Maya was in a lot of pain, she too wanted to die and go to heaven.
The doctor told her that the hospital could help her get resources to help, but Beata Kowalski declined the offer and said she was fine for now.
Dr. Teppa-Sanchez said she felt those statements were even more reason for Maya to receive psychological help though Beata Kowalski said she didn’t want that for her daughter at that time.
Dr. Teppa-Sanchez noted that she reached out to Dr. Sally Smith, a pediatrician who specialized in child abuse because she wanted her guidance on Maya’s case.
Johannah Klink, a nurse practitioner, also took the stand and told jurors she witnessed Maya moving despite pain from her Complex Regional Pain Syndrome. She said Maya opened up to her when her mother left the room.
"She said ‘I’m tired of all these lies, my life is a lie.’ That struck me very hard. I don’t know how to explain it when she said that it sounded like it was a cry for help, like she was desperate," said Klink.
Through jury questions, Klink said she didn’t follow up on that statement with Maya, but reported it to doctors.
"Maya would shut down, she would open up when she wanted to open up," she said.
Several hospital staffers were alarmed that her mother kept insisting she be given ketamine treatments for Complex Regional Pain Syndrome or CRPS.
The hospital did not agree with the treatment and called the Child Abuse Hotline. A judge ordered Maya to be sheltered at the hospital while the child abuse allegations were investigated. After 87 days of being separated from her daughter, Beata Kowalski, took her own life.
Pictured: Maya and Beata Kowalski
Now, the Kowalski family is suing Johns Hopkins All Children’s Hospital for $220 million, claiming the hospital’s actions drove Beata Kowalski to suicide.
Before the plaintiffs rested on Monday, psychiatrist Dr. Scott Richards took the stand and told jurors how he believed Beata Kowalski felt she had no choice but to end her life.
"I believe the impulse happened for Beata Kowalski when she finally had the impulse that ‘I can do no more. I’ve gotten everyone in my life involved, no one can seem to help,’" said Dr. Richards.
"I liken it to someone who is impulsively having emotions, they write an email, and they hit send, and they wish they hadn’t of send it. In this case there was no delete. You couldn’t unsend the impulse," he added.
On Tuesday, the defense called nurse practitioner Bonnie Rice to the stand Tuesday afternoon. She worked at Tampa General Hospital and was a part of Maya’s care team in 2015.
She said Maya’s case was frustrating for the medical team because she said Maya and her mother, Beata Kowalski weren’t open and she couldn’t move them down the road of recovery.
Rice added that Beata Kowalski was strictly seeking medical help for her daughter when the team at TGH suspected Maya’s pain may be psychological.
The team at TGH weren't the only ones to raise psychological suspicions.
On Monday, Dr. Lewis, a neuropsychologist and a consultant for the Child Protection Team, took the stand and told jurors he met with Maya after staff at Johns Hopkins All Children’s Hospital raised concerns that her mother may have been medically abusing her.
In a video deposition, Dr. Lewis stated that he believed Maya may have been suffering from a psychological symptom of pain, which may have triggered physical pain symptoms.
Pictured: Maya Kowalski
What Happened to Maya from ‘Take Care of Maya’?
The Kowalskis say they took Maya to Johns Hopkins All Children’s Hospital in October 2016 when she was experiencing a flare up of pain from CRPS.
Last Monday, Maya told jurors her condition would leave her screaming in pain and unable to walk at the time. She said she had been receiving ketamine to treat the pain and even underwent a ketamine coma in Mexico.
She explained that the ketamine treatment worked, and she was improving until the October 2016 flare up.
Pictured: Maya Kowalski
Her mother insisted that she receive ketamine at Johns Hopkins All Children’s Hospital, but hospital staff did not agree.
Beata Kowalski's persistence alarmed hospital staff, and they called in a report to the Child Abuse Hotline. They suspected Beata Kowalski, who was a registered nurse, was making her daughter sick.
When the hospital’s attorney, Howard Hunter, began his opening statements, he noted that several hospital staffers believed Beata Kowalski suffered from Munchausen by proxy (MBP) and they were trying to protect her.
Pictured: Beata Kowalski
Last Thursday, in a video deposition, Dr. Sally Smith, who was the medical director for the Child Protection Team providing a medical evaluation for Maya while she was at Johns Hopkins All Children's Hospital, said she knew that four other physicians had diagnosed Maya with CRPS.
She said she believed Maya’s mother, Beata Kowalski, was committing medical child abuse though she admitted that she had never testified in a case involving CRPS in the past.
Jurors watched a video deposition of Dr. Sally Smith on Thursday.
"Upon review of all the extensive medical records, observations of the child in the hospital, review of the unconventional treatments including hyperbaric oxygen treatment and high dose ketamine treatment repeatedly. It was my opinion that there was ample evidence of medical child abuse and it appeared Mrs. Kowalski was the primary one who was resulting in instigating or perpetrating child abuse," Dr.Smith stated.
Dr. Smith also said she recalled that Dr. Anthony Kirkpatrick, who diagnosed Maya with CRPS and recommended ketamine treatment, advised her not to move forward with allegations that Beata Kowalski was suffering from Munchausen by proxy.
Jurors also heard Smith say she suggested doctors at Johns Hopkins All Children’s Hospital take Maya off of all medications.
Maya and Beata Kowalski perform a figure skating routine.
Why was Maya kept away from her family?
A judge ordered Maya to be sheltered at the hospital while the child abuse allegations were investigated. She wasn’t allowed to be discharged to her family or another treatment facility and could not see her mother. A judge ordered her to remain at the hospital under state custody. Beata Kowalski died by suicide after being kept away from her daughter for 87 days. The Kowalskis say Johns Hopkins All Children’s Hospital medically kidnapped Maya and battered her while in their care.
Maya said, during her three months in state custody at the hospital, there was a 48-hour period where she was isolated in a hospital room. Maya said staff wouldn't help her go to the bathroom and, instead, tried to see if she could actually walk, but she couldn't.
A video of Marissa Higgins helping Maya try to walk was shown in court on Friday.
"They left me there for 48 hours under surveillance, which they did not tell me about. They had a commode in there, and they just put it far enough away from the bed. So, I would have to physically stand up and use the bathroom," said Maya. "I called the nurses whenever I had to use a bathroom because obviously, I'm not able to walk. And when they refused to help me go to the bathroom, I would defecate on myself."
She described some nurses as mean and unhelpful, and others as compassionate and willing to help. Her testimony on Monday was emotional at times as she expressed her frustration.
"When I express to them a symptom or like my pain, they would say, 'No, you're making it up,' or 'it's in your head,'" Maya said.
Jack Kowalski, Maya’s father, testified that his family was told they would be arrested if they left the facility with Maya.
He went on to describe how the hospital treated those who tried to visit Maya.
"Did you learn through the course of this that they believed Beata was slipping ketamine through the holy water and wafers?" the Kowalski's family attorney Greg Anderson asked.
"I know it didn’t happen, but they had all different ideas," Jack Kowalski replied.
Anderson argued those theories resulted in Beata Kowalski’s desperation and death by suicide.
"I saw my child deteriorating. I go home, I see my wife deteriorating," shared Jack Kowalski while on the witness stand.
Attorney Mark Zimmerman, who represented Maya when she was at Johns Hopkins All Children’s Hospital, said he felt as if the facility, and, in particular, social worker Catherine Bedy, tried to put up barriers for him to access Maya.
Beata Kowalski with Maya and Kyle
A phone call between Beata and Maya that was monitored by woman Maya identified as Bedy was also played in court.
Maya’s former Guardian Ad Litem, Jessica Blackrick, testified that Bedy cut a phone short a phone call in which Maya and her mother were praying together.
Blackrick added that a phone call that Maya wanted to make to her mother on Thanksgiving was blocked by Bedy because she couldn’t make herself available to monitor it.
Blackrick went on to state that she never told Bedy to monitor those phone calls.
Pictured: Maya Kowalski with boots on her feet.
Jurors watched a video deposition of Bedy, who the Kowalski family dropped its case against Bedy shortly before the trial began.
Bedy began her deposition by explaining how she was written up by the hospital after yelling at a co-worker after an attorney asked her if she had ever been disciplined at work.
The battery allegations from the Kowalski family stem from Bedy and others holding Maya down for unwanted photos and unwanted comforting.
She went on to describe how she met Maya and accused her mother, Beata Kowalski, of having Munchausen by proxy, but admitted she was not an expert on the disease and stated she had only worked with three similar cases.
Bedy said she saw Beata Kowalski demand ketamine for her daughter. Although the hospital says it believed the ketamine treatments were too dangerous, Bedy admitted that the facility did not take into consideration that Maya had been prescribed the ketamine treatments.
Maya Kowalski in hospital.
After seeing Bedy’s deposition, the jury was dismissed, while the court held a hearing on future evidence in the case. During the hearing, Maya’s father Jack Kowalski was asked about Bedy, and he said Maya couldn’t stand her.
"She stated she placed her on the lap. I never gave consent by the way on that. She stated that she used to come in and slap her leg to see if she was in pain, she said she wanted to adopt her that her mother was in a mental home, so she could be like her mother while in the hospital," he said.
Pictured: Beata and Maya Kowalski
Why was Maya taking ketamine?
Beata Kowalski, who was a registered nurse, learned about CRPS from an infusion patient and began researching the disease. Her research led her to Dr. Anthony Kirkpatrick, who diagnosed Maya with CRPS and prescribed ketamine treatments.
On Tuesday, jurors heard from Dr. Kirkpatrick, he told the jury that initially Maya said the ketamine treatments helped, but not enough so he recommended a high-intensity treatment in Mexico, which he said was a success.
"He explained the procedure. He talked about how it’s been around for quite a long time. He mentioned it’s used for many things, and it’s safe," Jack Kowalski stated during testimony on Monday. "The side effect when they’re coming out of it is a hallucination for a short time, but then everything is back to normal."
Upon cross-examination of Jack Kowalski, defense attorneys for the hospital questioned the family’s decision to move forward with ketamine coma treatment in Mexico.
"Were you aware that the risk of death from that coma was 50%?" asked Ethen Shapiro.
"There is a risk in every procedure," Kowalski responded.
"I understand that Mr. Kowalski but respectfully there’s a risk and then there’s a risk that’s a coin flip in which your daughter could pass. Did you know it was 50%" Shapiro pressed on.
"They stated it was 50%, but they stated no one every died from that procedure," responded Kowalski.
Side by side images of Maya Kowalski as she battled CRPS.
Maya’s father told the jury he and his family saw Maya slowly returning to herself following the ketamine therapy.
Dr. Kirkpatrick shared a similar testimony
"She could take care of herself, comb her hair, brush her teeth, eat with her hands and so forth" he recalled.
During a video deposition on Monday, Dr. Lewis stated that Maya had overheard doctors telling her mother that she had a 50 percent chance of dying during the ketamine treatment, which added to her anxiety.
When Maya relapsed in 2016, the Kowalski family says staff at Johns Hopkins All Children's Hospital didn’t agree with the ketamine treatments.
Maya Kowalski in the hospital.
Dr. Kirkpatrick said he discussed Maya’s condition with the hospital.
"I emphasized that if she doesn’t get the ketamine, it’s going to be a slow, painful death," Dr. Kirkpatrick stated.
Dr. Fernando Cantu, the doctor who administered Maya's ketamine coma, explained to the jury that while it will not cure CRPS, ketamine is a treatment for the disease.
Maya and her physician Fernando Cantu.
What is Complex Regional Pain Syndrome?
CRPS is a rare pain disease that can follow an injury, and it’s tough to diagnose and sufferers are sometimes accused of faking their pain.
There’s no cure for CRPS and treatments can range from acupuncture and nutrition to physical therapy and massage or ketamine therapy.
The Kowalski family attorney argued that the hospital staff refused to believe Maya had CRPS even after Dr. Kirkpatrick, who did not work for All Children’s Hospital, confirmed her diagnosis.
The Kowalski family claims that while hospital staff was accusing them of lying about CRPS and refusing to treat Maya, the facility was billing the family and their insurance more than half a million dollars for that exact cause of illness.
File: Johns Hopkins All Children's Hospital
Jurors will ultimately have to decide whether what happened to the Kowalski family could have been prevented and if the hospital’s actions pushed Beata Kowalski to take her own life.
"We ask in this case for you to consider not only compensatory damages to try to make them whole for these terrible things, but also punitive damages to deter them to punish them and to deter this type of behavior in the future," said Greg Anderson, Maya Kowalski’s lawyer.
Last week, an economist detailed expenses the family has incurred and will incur on the future and came up with $220 million.
On Wednesday, the judge told lawyers on both sides that they need to have all evidence, testimony and the rebuttal complete by November 1.