Defense Claims Girl's Illness Stumped Doctors, So They Blamed Salt Poisoning

The first time jurors saw a mother accused of medical child abuse interact with her daughter was yesterday, when the defense showed videos of Katie Ripstra with her three-year-old.

In the first video, Ripstra encourages her baby to take a spoonful of carrots as she sits in a kitchen high-chair. Then, at a park on her daughter's second birthday, Ripstra gives the girl a piece of train-shaped cake. Another video, this time at the hospital, shows doctors trying to feed the girl. It had been a nagging problem for Ripstra’s daughter since she was born—she would constantly throw up breast milk and then formula. When that didn’t get better, a pediatrician thought such therapy—essentially training the girl how to eat— would help.

But state prosecutors claim Ripstra’s daughter never needed therapy, was never sick, never had a eating disorder, and never needed any of the feeding tubes and IVs that would come to replace how Ripstra’s daughter ate. Ripstra has not seen her daughter for two years, after a child abuse doctor at Texas Children’s Hospital separated them, believing the girl’s severe sodium spike in August 2013 was due to salt poisoning. That doctor, who testified at Ripstra's criminal trial last week, also concluded that the girl’s frequent, sudden drops in blood level were due to intentional bloodletting.

Those who have seen the girl since she was separated from her mother say she's entirely healthy and eats like a regular kid. Ripstra now faces charges that could put her in prison for life. Jurors, it seems, will ultimately have to decide whether the girl coincidentally recovered from a rare disease (which she was never diagnosed as having) that her doctors didn't know how to combat, or whether Ripstra was savvy enough to poison her daughter and, in the process, stump the girl's doctors for three years.

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The picture prosecutors have painted of Ripstra seven days into the trial has been that, by reporting a consistent slew of confounding gastrointestinal symptoms to doctors, she was able to cajole them into believing her daughter would never be able to eat normally and therefore needed the feeding tubes. They claim this was all for the attention-seeking satisfaction Ripstra got when other moms offered sympathetic comments to her on Facebook. In less than two years, her daughter was hospitalized 26 times.

Riptra’s mother, Dawn Ripstra, however testified this week that she herself had seen the symptoms, and that at least six to eight times she was the one who brought her granddaughter to the hospital when she developed fevers over 101 degrees. On weekends, Dawn babysat the girl while Ripstra worked night shifts as a nurse at Texas Children’s—a job that prosecutors argue indicates Ripstra was capable of medically abusing her child for years.

Dawn had testified Monday that, when the child was learning to eat, she would often push the food away, and if they tried to coax her into eating more, she would throw it up. Yesterday Dawn testified that it was never Ripstra's decision not to feed the girl solid foods—it was doctors' orders. "We only fed her what they told us to feed her."

Ripstra's defense pointed to one doctor's report from October 2012, before doctors inserted a feeding tube into the girl's abdomen, that indicates Ripstra actually told therapists her daughter was making progress with the solid foods, and perhaps they could keep trying. Doctors decided to insert the tube anyway, something Ripstra's defense attorneys argue indicates shoddy medical care, not child abuse. 

On Tuesday, Ripstra's defense called in an outside kidney specialist at Stanford University's Lucile Packard Children's Hospital, Steven Alexander, who testified that the first time he looked at Ripstra's daughter's file, he immediately thought he was being asked to review a potential medical malpractice case. 

Much of Alexander's testimony focused on the near-fatal hospital trip Ripstra’s daughter took on August 6, 2013, when she suffered the worst of four sodium spikes that have since been called salt poisoning.

On that day, Ripstra's daughter's sodium level was so high that doctors say she could have died. So in the ER that morning, doctors immediately pumped fluids into her to resuscitate her. They ultimately brought her back to health, but because they could find no medical explanation for the spike, those doctors ultimately concluded that salt poisoning had made Ripstra's daughter ill. 

Alexander, however, says there's no reason to believe the episode was anything more than a case of severe dehydration.

Alexander questions why the ER doctors did not immediately call on a kidney specialist who would have been better suited to handle such a severe sodium spike. (Texas Children's chief kidney specialist testified last week that salt poisoning is what led to Ripstra's daughter's near-fatal hospital trip.) And he told the jury he's not unfamiliar with salt poisoning. Alexander even reported one case himself at his children's hospital in Palo Alto. Ripstra's daughter's illness, he testified, does not appear to be one of those cases.

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