Urine-injecting mum tampered with equipment, court hears
A girl whose mother allegedly injected her with urine had increasingly been admitted to hospital with symptoms not typical for someone with her genetic condition, a judge has heard.
The mother, a 47-year-old former nurse, denies using urine to endanger the life of her then nine-year-old daughter in Sydney's The Children's Hospital at Westmead in March 2015.
Her judge-alone trial in Newcastle District Court on Wednesday heard the girl, who suffered from a genetic condition and associated immunodeficiency, arrived at Westmead on March 4 with acute renal failure.
She was on the way to recovery when doctors noticed an unusual spike in certain "bugs" in the girl's blood on March 12.
A blood test taken from the central venous line showed microorganisms that hadn't appeared in a test on March 11 and that were consistent with an earlier test of the girl's urine.
Paediatric allergist and immunologist Melanie Wong said the bugs were high in number and likely to have come from outside.
"Usually, when there is only a small number, it can take a significant amount of time before (the blood cultures) come back," she told the court on Wednesday. "In this case, we found bugs growing only hours literally, six hours or so, after they were incubated." More blood tests showed unusual levels of the waste products urea and creatine.
"(It) was not typical and may have been consistent with the introduction of the urine into the body … via the line," she said.
Dr Wong said she was able to rule out several other possible reasons for the microorganisms in the girl's blood, including a heart condition. First admitted to hospital aged two, the girl had initially presented with symptoms typical of her condition, where some people can have episodes of unstable immunity.
But Dr Wong said the illnesses then escalated with many "atypical" for her condition, sometimes occurring monthly.
"(Early illnesses) were explainable and for the most part I was expecting her to get better," Dr Wong said.
"The immune deficiency is unlikely to explain the latter increase in infections she encountered." That differed from the history Dr Wong had of the girl's father and older sister, who share the condition but effectively outgrew the immunodeficiency.
The Crown alleges a search of the mother's bag on March 17 revealed a liquid- filled syringe, five used syringes, two urine sample containers, laxatives, a stool sample container and other medical equipment.
The mother, whose identity is suppressed to protect her daughter, said she had gathered the medical supplies when her child was transferred to Westmead from another hospital.
She told police she missed being a nurse and liked being involved in her daughter's care, the Crown said.
The woman - also accused of tampering with stool samples and twice illegally using laxatives on her daughter in 2014 - shook her head at times during Dr Wong's evidence.
The doctor told the court the girl, now 14, was placed into foster care soon after the alleged urine incident and has since improved "dramatically". That included having normal stools, eating lactose and being weaned off many medications.
Under cross-examination, Dr Wong said she wasn't aware of an offer from the girl's family to be placed under surveillance to better understand the constant illnesses.
She conceded maintaining the sterilisation of the central line could be a problem but the hospital had processes to reduce the risk for the closed system. Nurses had documented having to tell the mother to stop touching and altering the pumps connected to the girl's line, Dr Wong said.
The trial continues.
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