A Mother's Trial (30 page)

“Yes, that certainly entered into it. But also I had presented her case to a number of consultants who didn’t have a relationship with Mrs. Phillips, and no mention was ever made that this could be intentional poisoning.”

“As these various stool and urine samples were obtained, did the significance of those readings present itself to you?”

“Well, it was certainly a puzzling finding. But I had not had prior experience with electrolyte levels on stool. And Dr. Applebaum felt that for some reason Tia was secreting a lot of sodium in addition to losing water.”

Carefully, Josh led the witness through a description of Tia’s last hours. All in the courtroom could see how difficult it was for Sara to discuss it. Her voice becoming increasingly clogged, she described the final admission to San Rafael, Tia’s worsening breathing problems, her transfer to Kaiser-San Francisco, and the arrival of Dr. Leider to assess Tia’s condition.

“Dr. Leider was at San Rafael Kaiser that day. I knew he was going to return to San Francisco to consult on Tia and officially interpret her EEG. I wanted to be there at that time, and after office hours I returned to San Francisco Kaiser and was with Dr. Leider when he interpreted the electroencephalogram reading,” Sara testified, struggling now to maintain her composure.

“He confirmed that the brain wave reading was flat and he felt this patient had brain death. He discussed his findings with both parents. And a decision was made to stop all support systems.” She paused and tried to gather herself.

“And the patient was declared dead at approximately six-forty-five that evening.” Her head down, Sara stopped in tears. The jury shifted in their seats. Priscilla began to cry.

“If I may just have a minute, Your Honor,” Josh said, walking slowly back to his seat to allow the witness a chance to collect herself. Soon after, Judge Burke adjourned for the day.

Week 3

Although the direct examination of Sara Shimoda had consumed nearly two and a half days, Al Collins spent only just over an hour with this witness. He began by questioning Sara about a report from the Korean orphanage indicating that Tia had suffered from diarrhea for one month prior to the transfer to America.

“Were steps taken to find out what treatment there had been or what the cause was?” Collins asked.

“No.”

Collins paused, then brought up the case Caldwell had mentioned in his opening statement of the seven-and-a-half-year-old boy with symptoms similar to Tia’s. A Stanford consultant, Dr. Sinatra, had mentioned the boy in a letter to Sara. The child had suffered from secretory diarrhea yet his tumor had not showed up in either a laparotomy or on autopsy, Sinatra had written. Collins reminded Sara of this.

“There were differences in the two cases,” Sara remarked quietly to Collins. Josh, from his place at the prosecution table, cupped an ear.

“I didn’t hear that last statement. There were what?” he asked.

“Differences between the two cases,” Sara repeated more loudly. Thomas nodded and smiled.

“What were the differences?” Collins asked.

“The boy had an elevated VIP—vasoactive peptide—reading, where Tia did not. Also the boy did not have hypernatremia but had very low potassium levels and had to be given enormous amounts. Also the sodium in his stool was not as high as Tia’s.”

After the noon recess, Collins questioned Sara about Tia’s VMA. First, he underlined the fact that Tia’s VMA level was elevated whether one used Kaiser-San Rafael’s normal range or San Francisco’s.

In an oblique attempt to discredit the witness and her hospital, he followed with some questions about the Kaiser health plan system.

“Isn’t it true that although doctors’ salaries are fixed, the income of the system depends on profits?”

“Yes, it is.”

“And those profits could be affected by malpractice suits?”

“I suppose.”

Then, to separate Tia’s illness from Mindy’s, Collins raised a significant point. Mindy’s serum sodium exceeded a hundred fifty only once, while Tia had elevated measurements many times. He also demonstrated that on several occasions Mindy had exhibited low potassium readings, a condition not commonly true of Tia.

Finally, Collins had Sara repeat testimony about Mindy’s CMV and its possible effects, including small head size, and potential liver disease. It was an important part of the defense’s case that Mindy be seen as a child who was intrinsically abnormal because that could raise doubt about the cause of her diarrhea.

On redirect, Josh went right to the most telling point scored by the defense.

“Dr. Shimoda, I want to refer your attention back to the question concerning Tia’s VMA levels. In your consultations with Dr. Solomon—the endocrinologist—did she give you any information concerning the significance of those levels?”

“Yes. She said VMA could be elevated in a patient with no tumor. There could be other factors such as stress, certain dietary intake, starvation.”

On recross, Collins asked only one question.

“Doctor, laparotomies don’t always reveal the presence of a tumor, even if the tumor is there. Do they?”

“That would be possible, yes,” Sara agreed.

Sara was excused and Estol Carte took the stand, ending the day’s testimony with an account of his discovery of Mindy’s contaminated formula.

Dr. Michael Applebaum was next to testily. Applebaum had confessed to his wife a certain nervousness about testifying. The jury might legitimately wonder how he could now be so certain that Tia and Mindy had been poisoned and yet originally have diagnosed Tia’s illness as an undiscovered disease.

Applebaum had rarely felt comfortable around Priscilla Phillips. He was sympathetic to her and her situation during Tia’s hospitalization, but she had a nagging way about her, a certain belligerence, and a loud whiny voice that set him on edge. Even in the care of Tia, he had noticed that she was not warm, but rough and jostling. She was not the kind of parent who accepted the doctor, who told him to do what was necessary and trusted him to act competently. Everything was questioned; every issue a confrontation.

As he began to recount to the jury the treatments Tia had undergone at Kaiser-San Francisco, Applebaum was reminded of his difficulties with the case. In retrospect it seemed a crazy idea, but Mike had decided that Tia’s high stool and urine sodium levels were a reflection of what had been in her blood earlier. He knew it was possible to achieve much higher sodiums in urine than in blood without any significance being attached to the finding. So he had bottled all the symptoms together into some insane sodium mixture and concluded that Tia merely suffered a syndrome that included disequilibrium of her salt metabolism. With the benefit of hindsight, he now realized this conclusion had been moronic.

Only after Sara had called to tell him about Mindy’s illness had the seed of suspicion begun to ripen in Applebaum’s mind. But he had not placed Priscilla Phillips in the picture at that point, nor thought to test Mindy’s formula.

And even now, he had to admit to himself, though he had studied the records and become on some level convinced by what they revealed, there was a portion of his mind that balked at the notion that Priscilla Phillips was responsible.

He remembered visiting the Phillipses’ house after Tia’s memorial service. The house had been filled with many of the other mourners, but Steve and Priscilla had taken him aside and showed him about the house. They had led him into Tia’s room and pulled out pictures they had taken of her during her healthy periods.

“I am so grateful to you for allowing her to be home as much as you did,” Priscilla had cried.

And Mike remembered the four-page, hand-written letter Priscilla had written him after Tia’s death, thanking him for all he had done. That hardly seemed consistent with a murderer.

“We were frustrated by the lack of abnormalities,” Applebaum said now to the court. “The only thing we could find wrong with Tia was a low pancreatic enzyme. We eventually decided that this was a secretory diarrhea—it’s related to cholera in that there are fluid losses in the absence of mucosal damage—and we thought a substance in Tia was causing diarrhea and there were some candidates. VIP and prostaglandin were the two most likely. So we did a laparotomy and removed an adrenal gland.”

“Did you suspect that sodium was being administered?”

“No.”

“Why not?”

“I was trained as a physician to look for medical causes. And because it was happening in a hospital setting,” he said, echoing Sara Shimoda.

“I believe we’ve come to the time for our recess, Doctor,” said Judge Burke. “As you know, there is no court tomorrow, so we will reconvene at our normal time on Thursday. Remember not to discuss the case or form any opinion until the trial is completed,” he added to the jury.

As the courtroom emptied Ed Caldwell stopped for a minute to talk with the bailiff. It was not uncommon for attorneys to question bailiffs and court clerks about how well their points were coming across.

“How are we doing?” he asked.

“Okay. But you know your client is hurting herself.”

“How so?”

“Well, the way she’s always writing those damn notes and passing them up to you, and the expressions she gets on her face when she disagrees with a witness—like she’s overreacting or on stage or something. She doesn’t act like a defendant somehow. I know you can’t see her....”

“Yeah, thanks. She’s so intense and hyped up, you know.”

The guard nodded in sympathy. Ed crossed to the rear of the room and found Priscilla in the hall.

“You’ve got to cool it with the notes, Pris—it’s making a bad impression.”

“But I can’t stand it when they make a mistake. It drives me crazy.”

“I know, but save it and tell me later, at recess or lunch.”

“Okay, I’ll try.”

Ed smiled and patted her shoulder. He intended to telephone Dr. Satten to ask him how he felt about prescribing a tranquilizer for Priscilla—not enough to sedate her, but just to dull the edge of her anxiety. Dr. Satten was still seeing Priscilla, and he hadn’t yet reached a conclusion on her case. His delay was probably contributing to Priscilla’s anxiety, Ed thought ruefully. But the next day Ed received a phone call that would take his mind off that problem for a while. A call that would alter the direction of the defense.

On Thursday, Josh completed his direct examination of Mike Applebaum early. Although Collins was supposed to handle the medical witnesses, Ed had been enormously disappointed with his colleague’s cross-examination of Sara Shimoda, which he believed had been superficial. As a result, Ed cross-examined Applebaum himself. He took the doctor through a detailed description of Tia’s final illness. Applebaum mentioned that on occasion he had seen Priscilla adjust Tia’s IV. Later, he described Tia’s memorial service and his visit to the house afterward. In contrast to the ninety-minute cross-examination of Sara Shimoda, Ed’s cross-examination of Applebaum lasted all day.

Bonnie Pritzker’s direct testimony did not differ markedly from what she had said at the preliminary. She had conducted a more complete autopsy on Tia than was normal because Tia had been her husband’s patient; in fact he had given her a laundry list of what to look for in the examination, she testified. She had paid careful attention to the brain, spinal cord, pancreas, and remaining adrenal gland in her attempt to find a small tumor. She had found none and was absolutely certain in her own mind that none was there. She could find no pathological causes for Tia’s diarrhea.

On cross-examination, Al Collins established once again that a tumor could be microscopic, and that there was no way to establish by autopsy if Tia had died from sodium poisoning. Since one of the causes of Tia’s death had been listed as massive cerebral edema, Collins—in an attempt at introducing doubt as to the cause of this brain swelling—asked whether the edema might not have been the result of incorrect fluid replacement.

“It’s unlikely but cannot be completely discounted,” Bonnie answered. In his place at the defense table, Ed Caldwell turned to smile at Priscilla.

Josh Thomas then called Dr. John Iocco, Bonnie Pritzker’s supervisor, who had reviewed her autopsy results. His own findings agreed with Dr. Pritzker’s, he testified.

On cross-examination, Collins focused on Tia’s electrolyte imbalances, causing a series of objections by Josh Thomas, after one of which, Josh joked, “I better withdraw my objection because I forget what it was!”

“That’s a sure test for Friday afternoon,” Judge Burke riposted as laughter rippled through the courtroom. “A juror has handed me a question,” the judge went on. “Perhaps you can answer it, Dr. Iocco? ‘If a tumor was so microscopically small as to go undetected during an autopsy,’” he read, “‘could it have caused the diarrhea problem being experienced by Tia?’”

“I have never been convinced that it is possible for a tumor to be so small that a careful, thorough examination misses it. I’m just not convinced of that.”

“In the course of the autopsy, it is true, is it not, that the gross examination of the body does not involve inspection of every cell of tissue?” Collins asked at once.

“Yes,” admitted the pathologist.

“And the microscopic examination involves only a selected sample of tissues?”

“Yes.”

“Isn’t it possible that tissue that has not been examined either by the naked eye or been placed on slides could contain the microscopic tumors that we have been speaking of?”

Dr. Iocco answered as he had before. “I’m not convinced of that,” he said.

“What’s up next week?” Ted asked Josh at the end of the day.

 “The big guns—Stephens and Holliday.”

Ted nodded grimly. Those two doctors were the heart of the case because they had no ax to grind, no involvement prior to the investigation. They had convinced him he had a rock-solid case against Priscilla Phillips. Now all they had to do was convince the jury.

Week 4

San Francisco coroner Boyd Stephens led off Monday’s session testifying that Tia’s and Mindy’s high sodium readings could only be explained by an outside administration of sodium.