VENICE, Fla. — The fourth week of the "Take Care of Maya" trial began Monday at a Sarasota County courthouse with another set of doctors testifying for the defense.
The case involves a Venice family's $220 million lawsuit against Johns Hopkins All Children's Hospital regarding the treatment of their daughter, Maya Kowalski.
Doctors testified on Monday as to why they had several concerns about the nature of Maya's illness and why they suspected her mother, Beata, of Munchausen Syndrome by proxy.
The defense, with their witnesses, tried to establish that Maya Kowalski did not have Complex Regional Pain Syndrome to begin with. The lawyers argued that instead, this was a case of Munchausen Syndrome by proxy in Beata which caused her to amplify her daughter's illness.
One doctor said that he had communicated his suspicions about over-medicating Maya and a neurological component of her illness to her primary physician at least a year before she was taken to Johns Hopkins All Children's Hospital.
"From my reading of the documents I received before her second visit, I can only use the words, did not add up," said Dr. Elvin Mendez, the first witness to take the stand.
Dr. Mendez, an allergy and immunology specialist, said he saw Maya first in October 2015 and then for a follow-up in December 2015.
He said Beata brought her daughter in to get a second opinion on immunodeficiency concerns. He also said Mrs. Kowalski provided him with very detailed records of Maya's medical history, but he still requested the records from other physicians to review for himself.
"I was concerned about Munchhausen Syndrome by proxy at the time because the symptoms of the physical examination, the objective tests that I reviewed in the medical records did not correlate with the story I was getting from mom," Mendez said.
According to Mendez, Maya's blood work and other checks showed she had a normal immune system and indicated that something else, possibly a psychological component, could be contributing to her illness.
He also added that he was concerned about claims that Maya had "severe asthma" because it was inconsistent.
"We have someone with severe asthma admitted to the hospital for a few days and comes out with normal breathing test, and completely normal spirometry. The lungs just don't work that way" he said.
Mendez also testified that he did not contact the Child Abuse Hotline because he did not have the full scope of Maya's medical history to make such a serious report. Instead, he shared his concerns about the medication Maya was using with her primary physicians but did not get a response.
"The numerous steroids utilized, both inhaled, oral, and injectable forms in various ER visits, clinic visits providers, and in fact, she had access to I believe, steroids at home that she could provide her with," Mendez said.
While the Kowalski's contend mom Beata was looking for answers to her daughter's illness, the hospital's defense in the matter has been that staff acted in the interest of then 10-year-old Maya by weaning her off the medications and following orders from the Department of Children and Families by keeping her separated from her mother for 87 days.
"The allegation against us is that we created her state of mind. The pattern and practice of therapeutic and maternal care was dangerous to the child and that is why reports were made and suspicions were hatched," Howard Hunter, the hospital's lead counsel, said.
"Even if the defense was allowed to put in all of this evidence, they can't close the loop they have no expert on causation. They have no expert — they don't have an adult psychiatrist," Nick Whitney, counsel for the Kowalski Family, said.
The family is suing the hospital for medical malpractice, battery and false imprisonment for keeping Maya from them for 87 days.
They also blame hospital staff for Maya's mother's suicide over allegations of child abuse.