It was after the unexplained spikes in sodium levels that Dr. Eric Chiou contacted the medical child abuse team at Texas Children's Hospital.
He was already confounded by the unexplained drops in his 3-year-old patient's blood levels, the incessant vomiting and diarrhea that the girl's mother consistently described, and even a reported episode of facial twitching—a neurological symptom, he said—that his patient had never had before. Now the sodium spikes.
Chiou, who is a gastrointestinal specialist, could find no medical explanation for any of it, nor could any other doctors the girl saw over the course of three years. The young patient had seen a blood specialist, a geneticist, had been tested for an immune system disorder, allergies, red blood cell issues, even a brain tumor. Still, the doctors found nothing that could explain the severe symptoms that the girl's mother, Katie Ripstra, had been reporting to doctors. Ripstra continued to claim that her daughter couldn't eat without throwing up. As a result, her daughter hadn't eaten like a normal child since she was a year-and-a-half old; she was instead forced to take nutrition through tubes or IVs.
Ripstra now faces a maximum sentence of life in prison over charges she intentionally poisoned and medically abused her child. Chiou and Ripstra's daughter's doctor before him, Dr. Bruno Chumpitazi, both testified in court that they believe Ripstra was the one inflicting the myriad of infections, sodium spikes and steep blood level declines on her daughter. Ripstra could have tampered with her feeding tubes and IVs, they speculated. Since Ripstra was also a pediatric nurse at Texas Children's Hospital at the time, prosecutors also argued that Ripstra would be very capable of medical abuse. They claim she continued to bring her daughter to the hospital—more than 30 times in total—in order to continue gaining attention from doctors and concerned, sympathetic mothers who were members of a Facebook support group called Moms with Toddler Angst.
Both Chiou and Chumpitazi testified that, in hindsight, they don't believe the girl was ever sick, that she ever needed any tubes or IVs, or that she ever needed any medication or tests. They came to this conclusion in August 2013: The child-abuse team ordered Ripstra be separated from her daughter—and afterward, the mysterious spikes in the girl's sodium levels, the vomiting, diarrhea, fevers, infections and blood level drops subsided. After spending years puzzling over a confusing set of symptoms, doctors were stunned that, within a matter of weeks after this separation, all of the problems had disappeared. “It wasn't a gradual improvement,” Chiou said. “It was like night and day.”
However, during cross-examination, Ripstra's defense team shot back that Chiou was deciding to contort his beliefs to fit through a "lens of child abuse," and that, really, doctors simply weren't doing enough to properly diagnose the girl. Chumpitazi confirmed that, though it's possible Ripstra could have poisoned her daughter with salt through her feeding tube, he had no evidence. Nor did he have any evidence that Ripstra let blood from her catheter, which prosecutors speculated multiple times.
Defense attorneys also pointed out that Ripstra wasn't the only person caring for the girl at that time; the girl's aunt and grandmother were also caretakers, and also could have reported symptoms, Chumpitazi confirmed. When Ripstra's daughter was a baby, her aunt would make hour-long drives to bring the baby to Ripstra so she could breast-feed her at work, because the baby had trouble feeding from a bottle, one 2009 medical record showed.
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The defense also pointed to one October 2011 letter from a doctor in which Ripstra, shortly before doctors inserted a “G-tube” into her daughter's abdomen, reported that her daughter was improving, and she might do better if they tried more foods. It was the occupational therapists and Chumpitazi, though, who had recommended proceeding with the feeding tube. Both Chiou and Chumpitazi said that the medical history and symptoms Ripstra constantly gave them is what drove those decisions. “We don't usually second guess what parents tell us,” Chiou said.
Ripstra's defense attorneys insist that these were the wrong decisions, and that, actually, there was a medical explanation for what was happening to the toddler that doctors didn't adequately explore: something called mitochondrial disease.
The disease causes dysfunctional mitochondria, which are responsible for generating energy and are found in almost every cell in the body. This dysfunction can cause gastrointestinal disorders, vomiting, neurological symptoms like twitching, seizures, muscle weakness, fatigue, heart failure, and changes in heart rate or blood levels. Defense attorney Charles Peckham took Chiou through a list of many of these symptoms—many of which Ripstra had either reported or had been confirmed in previous medical tests. (For example, in 2010 doctors found that Ripstra's daughter had a problem with delayed stomach emptying, which might cause vomiting, Chumpitazi said.)
Even so, Chiou said that, because the genetic test results came back negative for mitochondrial disease, he had no reason to believe the girl suffered from it. He also added: “Mitochondrial disease is considered a chronic disorder you have for the rest of your life.” Meaning that, if Ripstra's daughter recovered during one long hospital stay, mitochondrial disease would be a hard case to prove.