Several nurses involved in a child’s care at hospitals around the country have been called as witnesses in a trial being heard in the High Court at Nelson. Photo / 123rf
Several nurses involved in a child’s care at hospitals around the country have been called as witnesses in a trial being heard in the High Court at Nelson. Photo / 123rf
A nurse “lurched forward” to grab a central line, which appeared to have been severed from a child in hospital, and says had she not done so, the outcome may have been fatal.
The nurse was giving evidence in the trial of a woman accused of mistreating her childduring medical care in hospitals and while at home.
The nurse was one of several giving evidence in the High Court at Nelson this week.
Another says she was puzzled over a stitch allegedly missing from where the line was attached to the child’s skin, and why there was “fresh ooze” on the dressing site.
A third nurse said she was unable to explain how a separate line carrying fluid nutrition allegedly became disconnected.
A trial involving a "complex medical case" is underway in the High Court at Nelson. A woman is defending seven charges broadly described as medical child abuse. Photo / 123rf
The mother, who has name suppression to protect the child’s identity, has pleaded not guilty to four charges of ill-treating a child and three charges of infecting with disease.
The mistreatment was alleged to have occurred over a 19-month period before the child was removed from the mother’s care, after a doctor reported suspected medical child abuse was at play.
The allegations arise from medical interventions required for the child’s assisted feeding and treatment for complex intestinal failure.
At various stages the child, whose mother claimed could not eat by usual means, was given nutrition intravenously and also via feeding tubes directly to the stomach and alternatively, into the gut.
The defence has argued the events arose from management of a “medically fragile child living with complicated medical devices” and the actions of a desperate mother trying to help her child who originally presented with suspected reflux disorder.
Several nurses involved in the child’s care at hospitals around the country have been called as witnesses.
This week they have been challenged on whether they personally witnessed any of the events they described, the accuracy of their medical notes and messages relayed across shifts, and their memory of events as outlined.
Registered nurse Alice Ritchie said during cross-examination she was alerted to the problem with the child’s central line, or venous catheter, when the mother notified her while changing the child’s pyjamas.
A venous catheter is also known as a Hickman line, used to deliver medications or nutrition directly into a vein.
Ritchie recalled seeing it allegedly severed, then “lurching forward” and holding it with her hands and yelling for help to re-secure it.
She explained it was a serious situation because air could get into the detached line, then into the heart and cause a pulmonary embolism, which could be fatal.
Ritchie said in cross-examination she had not understood it to be deliberate harm, as alleged by the Crown.
‘Missing stitch’
Registered nurse Holly Ward was involved in the child’s care during several admissions to a hospital between February 2019 and July 2020.
She provided general nursing care, helping with IV lines and gastric lines, and supported the family.
She described during lengthy cross-examination an instance when she noticed a stitch missing in the child’s skin during a change in the child’s Hickman line.
Such lines required surgical insertion and were secured with stitches at the entry and exit points.
Ward said it would have taken “a lot of pull” to remove the stitch.
She never saw the child grabbing at it, despite the mother telling her the child had been pulling on the line earlier.
Later that day, Ward said the mother took the child away for a few hours from hospital, but when she tried to call about a scheduled blood sugar level check, there was no answer.
The mother returned with the child at 8pm, and explained she was “giving [Child X] a rest” but Ward alleged the child would not have received the required amount of food in that time.
Ward said it was during a later admission that staff were allegedly told to keep close observations about the child’s pain and requests for medication.
“There was concern [the mother] was trying to dictate when pain relief was administered,” Ward said.
Child distressed during feeding
She also described how the mother would pin the PEG (Percutaneous Endoscopic Gastrostomy) drainage bag over the front of the child’s clothing so it was visible to others, how she tried to become friends with parents of others, her active social media presence and how she talked a lot about the child online.
Ward also said she saw the child distressed during feeding on a number of occasions.
She said the child was upset and pointing at the feed pump, crying.
Ward was told by the mother this was the child’s signal for not tolerating the feed, but Ward was unable to say if that was a result of the feeding itself, or the childhaving developed a negative association with the feed pump.
She said the child was almost always with a family member, and not necessarily the mother all the time.
Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.
