Doc Said Child Would Die Slow Death Without Ketamine
https://www.law360.com/articles/1730471?scroll=1&related=1
Law360 (October 10, 2023, 9:17 PM EDT) -- The anesthesiologist who first diagnosed Maya Kowalski, the child at the center of the Netflix documentary "Take Care of Maya," with complex regional pain syndrome took the stand Tuesday in the Twelfth Judicial Circuit to testify in the Kowalski family's suit against Florida's Johns Hopkins All Children's Hospital, telling jurors that he said Maya would die "a slow and painful death" at the hospital if she did not get the anesthetic ketamine.
Dr. Anthony Kirkpatrick, who runs a pain management clinic in Tampa, Florida, said he told Maya's mother, Beata Kowalski, that her daughter was in peril at the hospital, where then-10-year-old Maya had been taken in October 2016 with severe stomach pain.
"I emphasized that if she doesn't get the ketamine, it's going to be a slow, painful death," Kirkpatrick said.
Early in her three-month stay at the St. Petersburg, Florida, hospital, Maya was removed from her parents' custody by the Florida Department of Children and Families on suspicion of medical child abuse. The high doses of ketamine demanded by Beata Kowalski when they showed up at All Children's on Oct. 7, 2016, raised red flags for hospital employees, who called DCF. Beata Kowalski took her own life three months later.
The Kowalski family is suing All Children's for medical malpractice, false imprisonment, intentional infliction of emotional distress, false billing and other claims. The trial began Sept. 21.
Beata Kowalski was an IV infusion nurse, and the Kowalskis found Kirkpatrick after one of her patients overheard her on the phone with a nurse from Tampa General Hospital, where Maya had spent a month doing inpatient therapy in July and August 2015 after experiencing severe pain. Beata was unhappy with the hospital's diagnosis of conversion disorder, a mental health condition that causes physical symptoms, and her patient suggested that it might be CRPS, according to testimony earlier in the trial from Maya's father, Jack Kowalski.
CRPS is a type of chronic pain that typically affects an extremity after an injury and persists even once the injury has healed.
The patient led her to Kirkpatrick, who diagnosed Maya with CRPS, and not long after, began administering treatments of the sedative ketamine.
On the stand, Kirkpatrick testified that the first time he met Maya on Sept. 23, 2015, he noted two primary CRPS symptoms: extreme sensitivity to any type of touch, as well as dystonia in her feet, which were curved inward and which he said is common in children with CRPS.
"So when a child comes in with dystonia, you've got to be thinking CRPS," he said on the stand.
He testified that both Maya and her mother were "intelligent and inquisitive," and peppered him with questions about the treatments.
"It's refreshing to have a patient that gives you a little bit of a challenge," Kirkpatrick said. "She loved her child, and the child loved her mother."
Kirkpatrick said he first recommended that the Kowalskis try warm water therapy with Maya, who was then in a wheelchair, and expressed particular concern about the lack of mobility in her legs because of blood clots that could form there and cause a fatal pulmonary embolism. Not long after the initial visit, Kirkpatrick had her back for four days of what he called "conscious sedation," in which Maya received ketamine infusions, he said.
On cross-examination, the hospital's attorney, Howard Hunter, pressed Kirkpatrick on whether he had contacted any of the more than three dozen doctors Maya had seen before coming to him. Kirkpatrick said he had not.
Hunter also brought up a report dated Sept. 16, 2015 — one week before Maya's first visit with Kirkpatrick — from pediatric pulmonologist Dr. Anthony Kriseman that said "reflex sympathetic dystrophy is the most current diagnosis," referring to the older name for CRPS.
"Where would he have gotten that if not from the mother?" Hunter said.
Kirkpatrick responded that he did not know.
The anesthesiologist also testified that he later sent Maya to Kriseman to clear her for the ketamine treatment, but never talked to the pulmonologist or saw a report. When asked how he knew that Kriseman had cleared Maya for the procedure, Kirkpatrick said he relied on Beata Kowalski.
"I told the mother the basic question is, is there anything else that he can do to minimize her risk for the procedure since she has a history of cough asthma," Kirkpatrick said. "That's the only thing I wanted to know. The first time I heard it was from the mother when she came back for an office visit with the child."
Kirkpatrick also said he wrote a prescription for a peripherally inserted central catheter line and a prescription for IV fluids, electrolytes and nutrition to be administered by Beata Kowalski.
Maya, who is now 17, testified on Monday, telling jurors that doctors and nurses at All Children's mistreated her during her three-month stay and did not believe her when she said she was in pain. Since leaving All Children's in January 2017, about a week after her mother's death, Maya has been under a court-ordered treatment plan set up by All Children's that prohibits her from taking ketamine. She no longer uses a wheelchair and is now walking.
But despite this progress, psychiatrist Timothy Brewerton, who testified Tuesday morning for the plaintiffs, painted a bleak future for Maya and said that, in addition to her chronic CRPS, she is suffering from posttraumatic stress disorder, major depressive disorder and complex bereavement disorder. The PTSD, which Maya says is caused by the trauma of the separation from her parents and the hospital's treatment of her, will stay with Maya for the rest of her life, Brewerton said.
"PTSD becomes biologically embedded in the body, in the brain, in the person," Brewerton said. "We're learning more and more about the neurological processes of depression and PTSD, and how these mental disorders involve alterations in the brain."
The Kowalskis are represented by Gregory A. Anderson, Jennifer C. Anderson and Nicholas P. Whitney of AndersonGlenn LLP and Raymond T. Elligett Jr. and Amy S. Farrior of Buell & Elligett PA.
All Children's is represented by C. Howard Hunter, Ethen Shapiro and David Hughes of Hill Ward Henderson, Patricia Crauwels of Eastmoore Crauwels & DuBose PA and Chris W. Altenbernd of Banker Lopez Gassler PA.
The case is Kowalski v. Johns Hopkins All Children's Hospital Inc. et al., case number 2018-CA-005321, in the Twelfth Judicial Circuit Court of Florida. |
