A mother's actions and reactions are being scrutinised in a trial in which she is defending charges of deliberately ill-treating her child. Child X suffered a chronic illness that required intensive medical interventions for more than a year. The case is being heard in the High Court at Nelson. Photo / 123rf
A mother on trial charged with abusing her child during medical treatment was allegedly upset when she learned a round-the-clock observer would be placed in the hospital room.
However, her lawyer has argued this was because she was worried her privacy would be breached during her 24-hour bedside vigil of her chronically unwell child.
The observation was among hours of witness statements and cross-examination heard so far in a trial examining whether the child’s illness during treatment was the result of gaps in complex care or deliberate, as the Crown has alleged.
The mother, who can’t be named for legal reasons, has denied charges of ill-treating a child and infecting with a disease.
The allegations arose 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.
On two occasions, the child developed sepsis caused by a bacterial infection, which the Crown alleged was the result of deliberate contamination of the child’s central catheter line.
The Crown described it as a “complex medical case” and said the offending constituted “medical child abuse”, which was a doctor’s diagnosis when the child was discharged from a North Island hospital in January 2021.
The child was later removed from the mother’s care after a “report of concern” was made by a doctor to Oranga Tamariki. She was then charged in April 2023.
Another doctor involved in the child’s early care said during cross-examination there was a “miraculous” improvement in Child X, who began to eat normally, once the mother was removed from its care.
The defence argues the child’s illness was the actions of a desperate mother trying to help her “medically fragile child living with complicated medical devices”.
The defence case, led by Marie Dyhrberg, KC, is built around interpretation, hindsight and what someone might expect to find, and how that might influence recollections of what happened.
The trial, now in its sixth day, is being heard in the High Court at Nelson before an 11-member jury of five women and six men.
The catalyst for what followed was the arrival of Child X at a hospital outpatient clinic in early 2019 following concerns by the mother that her child was increasingly frail and not gaining weight.
Dyhrberg said Child X was assessed for failure to thrive and possible reflux disorder.
A former charge nurse at the hospital, who gave evidence today, recalled the child being assessed for possible reflux disease, which can cause inflammation of the oesophagus causing pain.
She had also witnessed the child in pain during attempts to increase feed volumes.
When asked by assistant Crown prosecutor Abigail Goodison the circumstances in which staff were alerted to the child’s pain the nurse witness said it was usually the mother ringing a bell for help.
“Other times we could hear [Child X] crying and we would respond.”
She described the child as crying, distressed, drawing its knees up and being “generally miserable”.
Extensive testing and intervention followed at the hospital in the South Island town where the family lived, and later, tertiary hospitals around the country as the child’s condition failed to improve and its needs grew more intensive.
In between hospital admissions, Child X was cared for at home by the mother, who had to be trained in the use of a myriad of techniques needed to manage IV lines and feeding tubes.
She was supported by hospital and community nursing staff.
Despite this, medical specialists were never able to pinpoint the source of the child’s gastric and intestinal problems over a 19-month period of trial and effort.
Evidence presented at trial indicated Child X was frequently in pain and distress, and that the mother became adept at understanding complicated medical terms and procedures.
“[The mother] appeared to me to be a caring, concerned mother, who was confident and competent in managing at home.
“She was a very intelligent woman and learned things very quickly,” a registered nurse said in her witness statement.
The same witness noted that while Child X wasn’t the first child cared for at home with complex needs, none of the others she knew had the level of problems and line breakages alleged to have occurred in this case.
The witness said she did not see anyone mismanage any equipment.
The former charge nurse at the hospital told the court the child’s mother was properly trained in how to use the medical equipment the child relied on for feeding, nutrition and medication.
She was also trained in strict hygiene protocols when handling lines and tubes because there was a risk of infection.
Dyhrberg asked if a constantly changing care plan as the child’s condition changed, made home care challenging, to which the nurse witness reponded it would.
She said the defendant and her sister, who played a supporting role, were “very organised”, and the system worked well initially.
She said a community nurse began receiving requests for increasing numbers of items linked to changes in Child X’s ongoing management plan.
“I had multiple conversations with [the mother] about getting the gut going and having food in gut, and how important this was to avoid long term problems.
“She appeared knowledgeable about intestinal failure,” the nurse witness said.
She said she was sometimes difficult to persuade her to try alternative care options, such as distraction techniques for pain management.
The witness claimed the mother had tried this and it had not worked, and that she favoured pain medication.
“On some occasions we tried to discuss reasons why [Child X] was upset.
“One of the main things that stuck in my mind was when she said, ‘[Child X] is not the same as any other child and doesn’t do things by the book’.”
The witness described the mother as “always appearing pessimistic” which she put down to a parent dealing with a child with complex needs.
“Sometimes she was tearful and upset, and other times she was calm and unflustered, but she always advocated for more testing and research to trace the source of the problem.”
In cross examination, the witness agreed there was stress in parents dealing with very ill children could fluctuate.
“It wasn’t outside what we see in parents of very unwell children.
“She is very articulate and definitely got her point across when needed, but sometimes her questions were a bit outside what other parents would ask,” the witness said.
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.