Early Wednesday afternoon, the defense for the hospital rested their case and the family's attorneys began to call rebuttal witnesses, including Jack Kowalski.
Prior to Maya Kowalski taking the stand for the last time, questioning of one expert witness created tension in the courtroom.
The family's attorneys called on Dr. Joseph Corcoran, an expert witness for the Kowalski family who served as chief medical officer at Brandon Medical Hospital, to testify to his knowledge of a Joint Commission review that indicated possible systemic failures at the hospital and an immediate jeopardy citation that had been issued.
Kowalski family attorney:Trial is about parents' rights to child's medical treatment
A jeopardy citation, Corcoran explained, is issued when there are widespread and egregious problems within an institution. Corcoran added he believed that the failure of the governing body of the hospital contributed to why the case was in court.
The family's attorneys believe the citation would have been around the time Maya was at the hospital as it was possibly related to an annual report conducted every three years, meaning Corcoran's testimony would be relevant to contest the defense's earlier testimony.
"The jury is left with a false impression based on the outline provided by the defense counsel to the expert that they passed with flying colors," Nick Whitney, one of the family's attorneys, said.
Several days earlier, a retired hospital administrator who worked at a children's hospital in Wisconsin and was asked to review Johns Hopkins All Children's Hospital's policies and procedures, had testified that the hospital had met accreditation standards in 2016.
The Joint Commission on Accreditation of Hospitals' purpose is to try and standardize the way hospitals provide care across the country, Mark Anderson explained. The commission identifies a series of standards of quality for each department that are evaluated on a routine basis every three years.
The hospital's attorneys claim the immediate jeopardy citation was only for the hospital's heart institute, and stemmed from a self-reporting situation, not the triannual review, meaning there weren't systemic failures.
However, both the family's attorneys and Sarasota Circuit Court Judge Hunter Carroll want to review the records and possibly depose a hospital representative to be certain that's the case.
“This thing kind of exploding on me on the last day of testimony, the last thing I want to do is make a wrong call on this issue, because this issue has the perspective of causing this whole thing to be done over again,” Carroll said.
He added that if the evidence is specific to one department, then it's probably not relevant to the case, but if it shows a systemic problem, it is relevant and could be used as proper rebuttal evidence.
Ethen Shapiro, attorney for the hospital, said in a statement that this appeared to be the plaintiff's "last-ditch effort to distract and mislead the jury."
“The issue raised has zero bearing on the compassionate, life-saving care that Maya Kowalski received while she was a patient at Johns Hopkins All Children’s Hospital," Shapiro said. "We are confident that the jury will weigh the relevant evidence and conclude what we have always known: that the care provided by Johns Hopkins All Children’s Hospital saved Maya Kowalski’s life.”
Last defense witnesses called; defense rests their case
“She was angry, she was crying, she was inconsolable. Sometimes she was, like in a rage, it was a very dramatic scene,” Dr. Jenny Dolan, the chief pediatric anesthesiologist at All Children’s, said Tuesday.
Dolan added she never in her almost 22-year career had seen such a young patient on such high doses of anesthetic ketamine.
Dolan recalled speaking with the family and being concerned, thinking she’d misheard the dosage amount that Maya had been receiving. She called Dr. Ashraf Hanna to confirm the dosage amounts, describing them as being “very toxic doses” to the jury. The doctor even called two other pain management doctors to confirm if her concerns were real before taking action to create short-term and long-term plans to wean Maya off the high doses while helping with withdrawal symptoms.
When Dolan suggested psychiatric counseling, both Maya and Beata became really upset.
“At some point, they used foul language, but they also said we are not crazy,” Dolan said. “We don’t need that. I said it’s not that I believe you are crazy. You are living with the burden of a chronic condition and you and your family need the coping mechanism to help with this process.”
Maya Kowalski didn’t appear to be in pain — she laughed, smiled, and was talkative.
Yet, when a nurse walked in to take Maya’s blood pressure on one occasion, her demeanor changed. The 10-year-old told her guardian ad litem volunteer she didn’t like having her blood pressure taken because it hurt.
Those were just some of the observations Sharon O’Leary Johnson, who had been a guardian ad litem volunteer in 2014, noted during the few visits she had with Maya, according to her video deposition played before the jury Tuesday. O'Leary-Johnson added during one November 2016 meeting, Maya told her she was in a lot of pain.
Wednesday morning, the defense called two of Maya’s floor nurses to testify, both recalling Maya as being a nice girl who loved Shopkins and was very modest and religious.
Amanda Flores stated as someone who is religious herself, she’d talk to Maya about God and pray with her, stopping by Maya’s room after her mom took her life to offer condolences and pray with Maya. Both nurses also recalled that Maya had a rosary and a prayer book, contradicting earlier testimony that Maya had religious artifacts taken away.
Flores added Maya always reported that she was in pain but couldn’t recall her writhing in pain when picked up to be moved to her wheelchair or to use a commode.
Family attorneys call Maya, Jack Kowalski back to stand for rebuttal
After the defense rested their case, Anderson called back several of the family’s witnesses, including Jack and Maya Kowalski, to rebuttal some of the testimony shared by the defense.
Maya Kowalski wore her signature light pink suit jacket as she took the stand for the third time, calling out the defense team for deliberately looking up her friend's Instagram account to find photos of her while at homecoming this year.
The defense showed several photographs of Maya smiling and laughing, as well as dressed up for homecoming to the jury on Wednesday. Maya told the jury that the last few years haven't been pain-free and the reality is, her CRPS symptoms wax and wane.
In her homecoming photos, Maya testified that she only went because her boyfriend had already bought the tickets and she didn't want to disappoint him. She told the jury she cried before going and only stayed for an hour before returning home.
Maya also contested former social worker Catherine Bedy's testimony, stating that in calls with her mother that weren't recorded, Bedy did in fact sit on her bed, holding the phone and making faces. She also wasn't made aware that in the two weeks before her mother's death, she was allowed daily video calls.
More trial coverage:Defense witnesses continue to question Maya's CRPS diagnosis
'Take Care of Maya' trial:Dr. Sally Smith testifies, as hospital cites 'chilling effect'
During Dr. Sally Smith's testimony, she said she’d come into the room wearing business casual clothing, a badge with the hospital’s logo indicating who she was, and introduced herself as a pediatrician with the Child Protection Team.
However, Jack Kowalski contested this in his initial testimony and in his rebuttal, stating he’d been busy taking care of Maya when a nurse exited the room and a woman in a white lab coat walked in, without introduction, and began asking questions in a raspy, cigarette voice.
Elina Kushnir, a Ukrainian mom whose testimony was translated by an interpreter, echoed Jack Kowalski’s testimony. Kushnir said when she was at the hospital with her son, a woman later identified as Dr. Sally Smith entered the room wearing a white lab coat with the hospital’s name and introduced herself as a doctor from the hospital.
The Kushnir family is also suing Johns Hopkins All Children’s Hospital and Smith after allegations of child abuse were brought forth against them and their children were taken away for a period of time. A judge ruled in favor of the Kushnirs, and the children returned home to their parents.
Jack Kowalski also addressed the emails that the defense presented to the jury written by Beata Kowalski in Maya’s voice, as if Maya had been the one writing them.
Jack believed his wife got the idea from baby books his mother had made for her children, which he’d shown Beata when they got married. The books documented firsts for the children as if they were describing what happened, “I lost my first tooth,” or “I got my first haircut.”
Beata Kowalski had made similar books for Maya and Kyle Kowalski, so that’s possibly why Beata wrote the emails in Maya’s voice.
Dr. Pradeep Chopra appeared via Zoom rebutting testimony that CRPS can't be generalized. Chopra told the jury he’s had multiple cases where patients had full-body CRPS, adding that every person is different. Sometimes one patient may have CRPS pain in one limb for 20 years without it migrating to other parts of the body, while another can have pain that spreads throughout other limbs.