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When Justina Pelletier arrived by ambulance at Boston Children’s Hospital seven years ago, she wore a diaper, and could not stand, walk, talk, or swallow. She was 14.

After running tests, speaking with former physicians, and consulting past records, the three doctors and one psychologist who cared for the teenager at the pediatric hospital found no medical reason that would fully explain her symptoms. That sparked a dispute with the teenager’s parents that led to a medical malpractice trial that went to the jury on Wednesday.

In 2013, doctors at Children’s suspected that Justina Pelletier was a victim of child abuse or neglect stemming from a rare psychological syndrome called Munchausen syndrome by proxy, in which a parent leads a child to believe they are sicker than they actually are and puts the child through unnecessary medical treatment.

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The doctors took their concerns to the state Department of Children and Families, which took custody of Justina Pelletier over her parents objections. She was placed in a psychiatric unit at Boston Children’s Hospital for nearly a year.

Those four caregivers — a neurologist, psychologist, psychiatrist, and former pediatrician — have been on trial in Suffolk Superior Court for the last month. Justina Pelletier and her parents, Lou and Linda Pelletier, have sued them for medical malpractice and negligence, alleging that they trampled the couple’s parental rights and caused Justina to have post-traumatic stress disorder.

On Wednesday, jurors heard three hours of closing arguments, capping nearly a month of testimony.

“No matter what you call it, there was concern" about the parents’ role in Justina Pelletier’s chronic health problems, said the hospital’s attorney, Ellen Epstein Cohen. "The key word was concern.”

If any of the doctors had “tossed those concerns to the gutter,” it “would’ve been reckless,” she said.

She pointed to stacks of white bankers boxes in the courtroom.

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“Eleven boxes of medical records for such a young life,” she said.

Lou and Linda Pelletier were reluctant, Cohen said, if not downright opposed, to acknowledging that their daughter needed intensive psychiatric help — or as Lou Pelletier put it: “psychological baloney."

“They were threatening, they were bullying, they were demeaning, and they were obstructive," Cohen said. In these ways, they interfered with their daughter’s improvement, she said.

It was the doctors’ duty to tell DCF if they suspected abuse or neglect. Under the law, they cannot be punished for making such a report unless it was done in bad faith, Cohen said.

There was not “a shred of evidence” that the doctors “intended to deceive or lie, that they somehow wanted to manipulate an outcome,” Cohen said.

To prove medical malpractice, the Pelletiers must have shown that the accused doctors’ care for their daughter deviated from the standards that govern their areas of expertise, Cohen said.

The Pelletiers relied on expert witnesses to do that, but failed, Cohen said.

Instead, they brought a philosopher, a retired rural emergency room doctor, and “professional witness” who had never treated children, she said.

“Anywhere in North America they couldn’t find a neurologist? Not one, not one to criticize Dr. [Jurriaan] Peters?" Cohen said. "Not one neurologist, not one psychologist?”

The four accused doctors, Alice Newton, Simona Bujoreanu, Jurriaan Peters, and Colleen Ryan, sat side-by-side in the front row of the courtroom, as they’ve done for more than a month.

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John Martin, a lawyer for the Pelletiers, said the doctors violated the hospital’s rules that called for bringing a patient’s primary caregivers into the fold. Their premise for notifying DCF was based on a foundation of intentional lies, he said.

“There was no reason to cut the parents out of her care," Martin said.

“The snapshot you’re seeing of [the Pelletiers] is a snapshot of the worst year of their life," he told the jury.

The doctors actively tried to prevent Justina Pelletier from reuniting with her family, tried to block the involvement of her former doctors, and omitted information from her medical records, Martin said.

They also lied to DCF when they said her mother had discharged her from a previous hospital against medical advice and that previous hospitals were blocking her return, and by claiming unfounded concerns like Munchausen syndrome by proxy.

The doctors emphasized that it was DCF’s decision to take custody from the Pelletiers even as they advised and guided the agency’s decisions, Martin said.

Claiming Munchausen syndrome by proxy is as serious as accusing someone of sexual molestation or physical abuse, Martin said, referring to testimony by Bujoreanu.

If you tell DCF you have concerns about Munchausen by proxy, “they’re going to act," he said.

'You will get the hammer and there is no way the doctors did not know that when they gave their recommendation,” he said.

He reminded jurors of e-mails they had read among the doctors, including one in which Ryan had referred to the family as “evil.”

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Those e-mails were “true reflections of how they really felt about this family," Martin said.

“When push came to shove, the parents fought, they fought, they fought to get her back, a true David and Goliath story," Martin said. "And they got her back.”

For the past two years, Justina Pelletier has been pain free and has not been hospitalized, Martin said.

“That’s thanks to her parents and what they’ve done for her.”

Jurors will begin their deliberations at 9 a.m. Thursday.


Tonya Alanez can be reached at tonya.alanez@globe.com or 617-929-1579. Follow her on Twitter @talanez.