The Suffolk Superior Court judge overseeing the medical malpractice trial brought against Boston Children’s Hospital by a chronically ill teen patient and her parents made it clear Thursday that he thought the civil case was thin, lacked evidence, and was short on relevant experts.
“You have to show more than just generalized evidence,” Associate Justice Anthony M. Campo told the Pelletiers’ team of four lawyers. “It’s not sufficient to say, ‘It’s in the medical records, figure it out.' ”
Campo’s remarks came after the family’s lawyers rested their case after nearly three weeks of testimony. The jury was not in the courtroom.
Justina Pelletier’s parents sued the renowned pediatric hospital and four caregivers they battled with over their daughter’s diagnosis and treatment in 2013.
The state Department of Children and Families took custody of their 14-year-old daughter and she remained in the psychiatric unit at the hospital for 10 months.
The lawsuit accuses a neurologist, psychologist, psychiatrist, and former pediatrician at the hospital of negligence.
“What has the jury heard about how they worked together?” Campo wanted to know. “You have to prove the case, every element of your case ...
“What I’m hearing from the plaintiffs is ‘they and them,'" he said. "It’s just grouping them all together.”
The entire medical team had worked together to prevent Justina Pelletier’s reunification with her parents, the Pelletiers’ lead attorney Kathy Jo Cook argued.
After a brief recess, Campo returned to the bench and tossed one of the lawsuit’s claims — an alleged violation of the Pelletiers’ civil rights by pediatrician Alice Newton.
Newton previously ran the hospital’s child protection unit for seven years. While there, she gained a reputation as a controversial and outspoken child abuse specialist.
Newton’s attorney said his client’s only involvement with the case was attending two meetings, not as part of the medical team but as part of the child protection team, in the first few days of Justina Pelletier’s arrival at the hospital’s emergency room.
“She never saw, spoke [with], or examined Justina Pelletier," Newton’s lawyer, John Cassidy, said. “She never saw or spoke with either parent.”
When the jury returned to the courtroom, lawyers for Boston Children’s Hospital called their first witness: Jurriaan Peters, a neurologist.
Peters, 45, testified that the extent of his care for Justina Pelletier was limited to five days, from her Feb. 10, 2011, arrival until Feb. 15, 2011.
He was instantly concerned, Peters testified.
“A 14-year-old who doesn’t walk, is incontinent for urine, who is lethargic and is unable to eat, drink, or swallow, can’t lift her arms and doesn’t make eye contact, that is very concerning," he said.
Within her first 24 hours at the hospital, Peters had either spoken with, or reached out to, the majority of Justina Pelletier’s former doctors, he said.
From each, Peters said, “I heard the same stories.”
“The same theme emerged with every phone call," he said.
The parents were difficult, their daughter’s behavior regressed when she was around her family, and there was no medical explanation for her problems, he said. Many held a high suspicion that there was a psychological or psychiatric component to her condition, Peters testified.
A former neurologist told him that Justina Pelletier’s treatment was “complicated by very nice, intelligent, well-intending parents," medical records showed.
As a result, that neurologist concluded, Justina Pelletier may have “developed a pathological feedback loop” where her symptoms, when expressed, were validated by her parents.
Peters translated that into laymen’s terms: “Anytime a person says they’re sick, then it’s endorsed or validated.”
He questioned the mitochondrial disease diagnosis that Linda Pelletier insisted her daughter had, “but I didn’t discard it," Peters said.
His medical notes also reflected his "concern with mom’s black and white thinking.”
Her daughter’s doctors, in Linda Pelletier’s opinion, had been either incompetent or unsatisfactory, or exceptional and unique, Peters told the jury.
“There was little room for gray or maybe,” he said. “It was either/or. It was either really good or really bad.”
Justina Pelletier’s medical history, Peters said, was filled with classic red flags for “over-medicalization” at the hands of her parents.
She had a “patchy network of providers,” she took numerous medications — some prescribed to combat side effects of other drugs — and “I saw a big, big, big number of tests,” he said.
“When there’s no single person ... who is coordinating all this care, it gets risky,” Peters said.