SARASOTA COUNTY, Fla. — Witnesses for Johns Hopkins All Children's Hospital continued to paint a different picture of Maya Kowalski's experience inside hospital walls.
One hospital nurse testified that aside from her physical therapy, Maya engaged in activities like cookie exchanges, fun activities and nurses awards and was provided with personalized laundry assistance.
Over the past eight weekdays, defense witnesses have shown an alternative view to the Kowalskis' narrative including attempting to debunk Maya's illness.
"All of the rooms are open and bright. None of our rooms are painted just plain white, they are all pastels," said Lisa Rek, a charge nurse at All Children's Hospital.
Rek said she did some of Maya's charting and helped with her personal grooming activities and hygiene.
"She could brush her own hair, she could brush her own teeth and she could wash her own face," Rek said. "With her modesty, she preferred to dress herself."
Rek said Maya enjoyed lots of arts and crafts, including painting and ward activities, especially for the holidays.
"Halloween parties where instead of the kids going trick-or-treating, different departments come to the unit and then they give kids either candy or other items," she said.
After a fall when she tried to get to the restroom, Rek said Maya required more supervision and surveillance.
"We, of course, would have the side rails up but if for some reason she was able to get out of the bed, we wouldn't want her to sustain a fall," Rek said. "If she was moving from the bed to the wheelchair, we would always be by her side to help her pivot from one position to another."
Rek said she and other nurses were just doing their job often going above their call of duty.
"I took her laundry home on two occasions, washed it, and brought it back to the hospital," Rek said. "When I was helping her change, she was very low on clothing options so I thought to help her have as much as possible.
"I worked on the day, asked her if it was OK to take them home and I went home after working 13 hours, did her laundry, and came back the next morning. Primarily because I wanted her to have the options."
But during the session where jurors' questions were read out by Judge Hunter Carroll, Rek was pressed further about taking Maya's laundry home and whether she had gotten permission from her parents.
"Really we could've called it a day and just put her in a hospital gown when she ran out of her personal clothing, but I didn't want that to happen," Rek said.
Jurors also wanted to know why and if Rek found out why Maya had been moved into an EEG room and was put under video surveillance for 48 hours, plus if she showed any concerns or curiosity.
"Outside of just moving from one room to another room, nothing changed," Rek said. "It's really not nursing's place to make a diagnosis or order new testing. So at that point, we would have been relying on a physician staff to determine what information they were hoping to get from watching her on video."
On cross-examination, the attorney for the Kowalskis, Greg Anderson, challenged Rek on how close she claimed she was with Maya.
"In fact, you only saw Maya charting in on five occasions," Anderson stated.
"I am a point person for admissions, transfers and discharges and I have an idea of why every patient is in the hospital at the time that they are there," Rek responded.
Also on the stand was an administrative executive and former administrator for All Children's Hospital in Wisconsin who reviewed hospital policy and procedures for the defense team to assess if they were in compliance with standard care. This official also laid down rules and guidelines.
Mark Anderson said the situation with Maya was conducted appropriately to the level of care required and appropriate to the policies and procedures of the hospital.
"It is very common that there are multiple orders, shelter orders in place, and that senior leadership would not necessarily intervene on those cases as long as the care of the patient was proceeding and was not rising to the level of crisis, and that the patient was stable," Anderson said. "From the records that I saw, and from the chart that I saw, and the way that they have organized the hospital, their framework for managing safety issues, patient care issues is there.
"From what I saw in the record, there is internal communication going on daily, on a real-time basis, relative to the patient's care. So I believe that Johns Hopkins does have appropriate models for the safety of their patients."
The defense, with their witnesses, tried to establish that Maya did not have Complex Regional Pain Syndrome to begin with. The lawyers have argued that instead, this was a case of Munchausen Syndrome by proxy in Beata Kowalski, Maya's mother, which caused her to amplify her daughter's illness.
One doctor who treated Maya in October 2015 and then in December 2015 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, where the case was then flagged for medical child abuse by staff over the use of high doses of ketamine.
Dr. Sally Smith, the pediatrician and former Pinellas child abuse investigator who looked into the reports of medical child abuse against Maya's parents, was expected to testify this week. However, the judge has restricted discussions about the DCF report related to the sheltering of Maya at the hospital.
In light of that, it is uncertain if and when Smith would testify and what she would be able to contribute from the witness stand that would be different from her video deposition which was entered into evidence and played back for the jurors.
The Kowalski family is suing the hospital for medical malpractice, battery and false imprisonment for keeping Maya from them for 87 days starting in October 2016 to January 2017.
They also blame hospital staff for Maya's mother's suicide on Jan. 7 over allegations of child abuse.
The family is suing Johns Hopkins for $220 million.