Gabriela SzymanowskaSarasota Herald-Tribune
Maya Kowalski is expected to take the stand early next week in the civil case against St. Petersburg-based Johns Hopkins All Children’s Hospital, with attorneys for the Venice family expecting to rest their case by the end of the week.
Greg Anderson, lead counsel for the Kowalski family, informed the judge that he will most likely rest his clients’ case by Oct. 13 despite having to shuffle the order of his witnesses due to sickness. If Anderson does rest his case on Oct. 13, this will give the defense two weeks to present their case, with closing statements and jury deliberations expected at the end of the month.
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The Kowalski family sued All Children’s Hospital in 2018 for false imprisonment, negligent infliction of emotional distress, medical negligence, battery, and other claims more than a year after the family matriarch, Beata Kowalski, took her life following allegations she was abusing her daughter.
The family took 10-year-old Maya Kowalski to All Children’s Hospital in October 2016 after she complained of severe stomach pain, believed by the family to be a relapse of her Complex Regional Pain Syndrome, a disorder that impairs the central nervous system and heightens pain sensations. The illness is sometimes also referred to as Reflex Sympathetic Dystrophy Syndrome.
Maya Kowalski was separated from her family, friends, and community following a Florida Department of Children and Families investigation and ordered by a judge to remain at the hospital. She remained separated for three months before reuniting with her father and brother shortly after her mother’s death.
‘From extreme frustration to desperation’: Maya’s former attorney describes
Sarasota attorney Mark Zimmerman was asked to represent Maya Kowalski while she was in state custody at Johns Hopkins All Children’s Hospital in late 2016, visiting her twice at the hospital.
Zimmerman, who appeared in court via Zoom while in Greece, said he made it clear to Maya’s parents and their attorneys that when he was hired he would be representing Maya’s interests and legal needs.
His first impression of Maya when he met her outside of her hospital room was that she was very mature for her age, articulating her wishes and concerns very clearly to him. He added that Maya seemed miserable and over time she appeared to be “emotionally withering.”
While the two weren’t immediately allowed to speak in private, having their first meeting in a hallway where Maya lowered her voice so she wouldn’t be overheard, Zimmerman was eventually permitted to speak alone with Maya in her room, but the door had to remain open, he said.
Patricia Crauwels, one of the hospital's attorneys, pointed out that it’s not uncommon for a 10-year-old child to assign blame to someone in a stressful situation.
“She went from extreme frustration to desperation. She felt like a prisoner,” Zimmerman said.
Zimmerman said it felt like hospital staff and Bedy were suspicious of him and were putting up barriers for him to see his client.
In response, Crauwels also pointed out in her questioning that there were shelter and visitation orders in place that the hospital staff had to follow. Zimmerman agreed that hospital staff were complying with the orders as they interpreted them.
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Doctor who performed ketamine coma flies in from Monterrey, Mexico
Dr. Fernando Cantú Flores, an anesthesiologist specializing in pain medication, was called to testify Wednesday and described via an interpreter for the jury how a ketamine-induced coma works and Maya's procedure.
The doctor said Dr. Anthony Kirkpatrick, with whom he'd done a ketamine coma study, had referred the Kowalskis to him in November 2015 after Maya had been diagnosed with CRPS and it appeared that all other treatments weren't working.
Over the hundreds of patients Cantu had seen over his 20-year career, he said Maya was the youngest patient he treated with a ketamine coma. Prior to the procedure, Cantu vetted Maya to ensure she was a good candidate for the procedure.
During the procedure, Cantu explained that Maya Kowalski had around-the-clock monitoring — she was hooked up to several machines, was intubated, and had doctors and nurses observing her, she also had blood samples taken daily throughout the treatment as the ketamine dosage was slowly increased to the highest dosage Maya received over a five-day period.
Once Maya was fully awake following the procedure, Cantu said she had significantly improved: her dystonia, or the contraction of muscles, in her feet was better, she was sitting up in her wheelchair and her mood had improved.
Following that trip to Mexico, Maya returned a few weeks later for a booster, where she received 2,000 milligrams of ketamine over a two-hour period.
Anderson also asked Cantu if there were any withdrawal symptoms that he'd observed from Maya, to which the doctor said there were some hallucinations, but the withdrawal symptoms were not like opioid withdrawal symptoms.
Howard Hunter, lead counsel for the hospital, questioned Cantu about the other risks of placing Maya in a coma, including the possibility of risk of infection from the length of intubation. While Maya did have a minor infection, Cantu said, it was easily treated with an antibiotic.
When the defense further pressed Cantu about the fact that the procedure had a 50% risk of death probability, Cantu said that with any procedure there is a risk of a severe adverse effect, but he wouldn't do the procedure if a patient had a 50% chance risk of death.
Hunter also pointed out that even after the ketamine coma, Maya Kowalski had dystonia in her feet, was wheelchair-bound, still had lesions on her legs, and required additional boosters as she still had pain.
Cantu stated that while the ketamine coma helps treat symptoms of CRPS and can help reset a patient's body for a period of time, it's not a cure.
"It is a dream ... I really wish I could find a cure for patients with this disease," Cantu said.
While Cantu was aware Maya Kowalski was receiving ketamine booster infusions after her procedures in Mexico, he was unaware she received 55 ketamine booster infusions between January and October 2016, or that she suffered a relapse of her CRPS. Cantu added he received an email from Beata Kowalski that said Maya was improving.
Child psychiatrist: Maya Kowalski diagnosed with depression, PTSD
Dr. Jacqueline Henschke, a child and adolescent psychiatrist who saw Maya Kowalski four times in 2022 and 2023, diagnosed Maya Kowalski with major depression disorder and chronic post-traumatic stress disorder, detailing how Maya was coping after her mother's death, her stay at All Children's Hospital and the lawsuit.
Henschke admitted that Maya's condition and what she went through will have a lifelong impact on her, that she will look at the world differently, and see it as more hostile and more threatening.
"It's going to be a lifetime struggle for her," Henschke said.
Henschke first saw Maya Kowalski in October 2022 at the behest of Anderson, who had run into Henschke at a community event in Jacksonville and asked if Henschke would consider being a safe space for Maya Kowalski to confide in.
Henschke said that during that first visit, Maya Kowalski wasn't doing very well as she had more flare-ups because of her CRPS and was exhibiting symptoms of depression, anxiety, and PTSD.
Maya Kowalski confided that with her CRPS she felt alone and misunderstood and that after her stay at the hospital and her mother's death, "it was a different kind of sadness." She also said she avoided going to doctor appointments and had anxiety going over the Skyway Bridge and being in St. Petersburg. She withdrew from physical activities like ice skating and school sports because she feared getting hurt and having to go to the doctor.
In December 2022, Maya Kowalski started working at a Cracker Barrell where she experienced a panic attack after she saw a woman who looked similar to Bedy. Maya told Henschke she felt her stomach drop, and her heart rate increase, and despite feeling scared and wanting to leave, she felt embarrassed to tell her boss, so she stayed feeling anxious the rest of the shift, Henschke testified. By their last session in January 2023, Maya was looking to leave her job.
When Ethen Shapiro, a defense attorney for the hospital, questioned Henschke, he asked if she had reviewed a note by a neurologist who indicated Maya Kowalski experienced severe anxiety and depression after learning that the ketamine infusion had a 50% of death and cost her parents a lot of money. Henschke acknowledged she saw the report but thought there was a lot of confirmation bias.
Maya Kowalski stopped seeing Henschke after she learned that her records would be subpoenaed, Henschke said in response to a question from a juror.
Henschke was also asked by a juror why she only saw Maya monthly if she recommended weekly therapy sessions, to which Henschke said there aren't enough child psychiatrists and she primarily met with Maya to help with medication management.
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Jury watches depositions, including social worker Catherine Bedy's
The jury on Thursday morning watched two depositions — one of psychologist Rebecca Johnson and the second of social worker Catherine Bedy — before being dismissed for the rest of the day.
During Johnson’s deposition, the jury learned that Maya Kowalski, as well as the rest of her family, had several counseling sessions with Johnson starting in 2015 and continuing after her stay at All Children’s Hospital.
Johnson first spoke with Maya Kowalski at Eagle’s Wings, a counseling center, in November 2015 after Beata Kowalski spoke with Johnson about having Maya become a patient. Johnson admitted that she didn't review any outside records prior to speaking with Maya Kowalski, including psychiatric records from Tampa General Hospital and Lurie's Children's Hospital in Chicago. Johnson was aware of the fact that Johns Hopkins All Children's Hospital records included diagnoses for factitious and conversion disorders.
Johnson said that Beata Kowalski did not abuse her daughter, Johnson said that when she saw Maya she "only perceived love and care from her parents."
Additionally, when asked if she felt Beata Kowalski needed to be placed under the Baker Act, which allows doctors and policein Florida the power to place an individual into involuntary mental health treatment for up to 72 hours, Johnson said no.
When asked why Maya Kowalski had an almost three-year gap in counseling between May 2017 and January 2020, Johnson didn't know and denied recommending the break, but said she believed both Maya and Kyle Kowalski were pretty overwhelmed and needed to take a break.
Catherine Bedy, a social worker who worked at All Children’s Hospital and was assigned to Maya Kowalski’s case, was deposed on Jan. 30, 2019, according to the timestamp of the video shown to the jury.
Anderson began his deposition of Bedy by questioning her about an incident where she was disciplined for yelling at a co-worker around the time Maya Kowalski was at the hospital. Bedy answered that she was written up for the incident but wasn't required to go through any retraining.
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Bedy testified that she wasn’t an expert in CRPS or Munchausen by Proxy but clarified she had previously seen two or three patients with the condition and had specific training on Munchausen syndrome in graduate school.
When asked by Anderson if she could list the top five symptoms for Munchausen by Proxy, Bedy seemed to struggle, listing that the parent seeks multiple medical professionals in order to get diagnoses on very vague symptoms, children may be checked into several ERs, parents are unwilling to provide information from other healthcare providers, parents demand treatments that are currently not aligned with the proposed treatment plan and parents seem very attentive.
Bedy also told Anderson that Maya’s pain, or the symptoms she observed, were different from the other patients she’d had who had CRPS — those children had been bed-ridden for days at a time, while Maya Kowalski spent most of her time in a wheelchair, Bedy said. She further added she observed Maya moving her legs and arms multiple times.
“She cried, but not while she was in pain,” Bedy said.
When pressed about the fact that the hospital took “a little girl away from her parents” because of a dispute over a dosage of medicine, Bedy replied that the hospital didn’t take Maya Kowalski away, it was a court order that placed her in protective custody.
Anderson also questioned Bedy about the fact that when Maya’s attorney, Zimmerman, visited her in the hospital, they had to leave the door cracked. Bedy said that there had been an episode where Maya claimed she fell out of her wheelchair and was lying on the floor for hours, and risk management wanted the door to remain open at all times so staff could have eyes on her.
Gabriela Szymanowskacovers the legal system for the Herald-Tribune in partnership with Report for America.You can support her work with atax-deductible donation to Report for America.Contact Gabriela Szymanowska atgszymanowska@gannett.com, or onTwitter.
