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Defense Claims Rare Undiagnosed Disease, Not Child Abuse, Made Woman's Daughter Sick

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Dawn Ripstra's granddaughter was three years old when she started taking her to the hospital. Doctors had instructed Dawn's daughter, Katie Ripstra, to bring the toddler to the emergency room if the girl had a fever over 101. The girl had been getting nutrition through an IV because whenever she would eat by mouth, she would often vomit, Ripstra claimed. Dawn had seen it herself. 

On Monday Dawn testified in her daughter's criminal trial. Ripstra faces a life sentence for two counts of intentionally injuring her child. Prosecutors claim Ripstra falsified or exaggerated many of her reports that her daughter couldn't eat without vomiting, or had chronic diarrhea, in order to gain sympathy and attention from concerned doctors and other mothers on a Facebook support group. No doctor—including gastrointestinal specialists, geneticists and blood specialists—could figure out what was wrong with the girl. It wasn't until a child abuse doctor at Texas Children's Hospital ordered the girl be separated from Ripstra that all of these symptoms, sodium spikes and blood level drops disappeared, leading doctors to conclude it was medical child abuse all along.

But Dawn testified that she had been noticing feeding abnormalities in her granddaughter since she was born. She babysat her every weekend while Ripstra worked 12-hour night shifts as a nurse at Texas Children's Hospital—a fact that the state has used against Ripstra, arguing this would make her capable of medical abuse. When Ripstra's three months of maternity leave were up and Dawn began taking the baby on weekends, Dawn would have to make the hour-long drive to Texas Children's so Ripstra could breastfeed her during her lunch break, because otherwise, “she wouldn't take the bottle,” Dawn testified. “And I couldn't have a baby not eat for 12 hours. It was awful.”

Dawn expected the problem to resolve itself over time, like it had in her own daughter—but instead it only got worse. Around age 3, Dawn says doctors recommended the girl stop eating solid foods entirely; this time they suspected severe allergies. Dawn would take her granddaughter to the hospital six to eight times that year, and each time, she was admitted for three to five days. Doctors were concerned that, with fevers that high, the girl might be susceptible to dangerous infections from her feeding line. And many times, that was the case. 

But because the infections were so frequent and often included multiple bacteria—which doctors, called by the state, said was highly unusual—prosecutors allege these infections were deliberately caused by Ripstra. They claim Ripstra put saliva, mucous, feces, or farm animal bacteria on the girl's feeding line.

Defense attorneys called to the stand Dr. Richard G. Boles, who specializes in “mitochondrial diseases” at Children's Hospital Los Angeles. He claims the girl suffered from this disease, which made her more susceptible to line infections.

Mitochondrial disease causes dysfunction in the body's mitochondria cells, which are in charge of generating energy. A patient will likely exhibit a combination of symptoms including vomiting, diarrhea, nausea, fatigue, inconsistent and unstable vital signs, intense fevers, and anemia. Boles said that, from looking at the girl's medical records, Ripstra's daughter exhibited all these symptoms. 

Prosecutors last week argued the girl could not have had this disease for two main reasons. For one, a geneticist ran seven tests to see if she had it, searching in some cases for one of its rarest forms, and he came up empty handed on all occasions. Plus, mitochondrial disease has no cure, according to several of the doctors who testified last week—so how could Ripstra's daughter have recovered that quickly?

Boles, however, explained that often the disease is misdiagnosed or missed completely for years. He said doctors should have done more tests, and that the ones they were doing weren't always right. Boles also claimed that while it appears the girl "recovered" from her illness, of the roughly 1,000 patients he's treated with mitochondrial disease, some patients go into remission for one year or even 10. And so it's possible that this could be the case for Ripstra's daughter—but doctors would have to wait and see.

Boles, who also testified during direct examination that he was paid $18,000 for his time on the case, concluded after reviewing the medical records that there was no evidence of salt poisoning or blood letting whatsoever. To explain the sodium spikes, Boles pointed to severe dehydration that mitochondrial disease patients often suffer from. And as for the sudden drops in blood levels, Boles pointed to a possible kink in the way the girl's bone marrow makes baby red blood cells—an immune system problem common in his patients, he said.

Other witnesses testified that Ripstra's daughter has been healthy for two years. She eats like a normal child. No tubes, no vomiting, no diarrhea, no fevers beyond the common cold.

Prosecutors asked Boles if he would still choose, right now, to do another type of testing, like a muscle biopsy, on the now-healthy girl to determine if she had mitochondrial disease. The muscle biopsy is often the most costly and invasive method, usually a last resort. But Boles replied, “Yes, because this result will matter if you put this mother in jail for the rest of her life. I would want to know.”

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