Ripstra v. State

514 S.W.3d 305, 2016 Tex. App. LEXIS 13778, 2016 WL 7478358
CourtCourt of Appeals of Texas
DecidedDecember 29, 2016
DocketNO. 14-15-00842-CR, NO. 14-15-00843-CR
StatusPublished
Cited by9 cases

This text of 514 S.W.3d 305 (Ripstra v. State) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ripstra v. State, 514 S.W.3d 305, 2016 Tex. App. LEXIS 13778, 2016 WL 7478358 (Tex. Ct. App. 2016).

Opinion

OPINION

Martha Hill Jamison Justice

In four issues, Katie Alice Ripstra appeals her two convictions for felony injury to a child. She challenges (1) the legal sufficiency of the evidence in support of the jury’s guilty verdicts; (2) the trial court’s denial of her motion to exclude statements made during voir dire and motion to suppress statements she made to her child’s guardian ad litem; (3) the trial court’s admission of her Facebook posts; and (4) the trial court’s exclusion of certain expert testimony. We affirm.

Background

Appellant was employed as a pediatric nurse for Texas Children’s Hospital. Her daughter, Rachel, was born in August 2009.1 By October, appellant began reporting to Rachel’s pediatrician that Rachel was having acid reflux and spitting up her milk. As these problems purportedly continued, in February 2010, Rachel’s pediatrician referred Rachel to a pediatric gastroenterologist, Bruno Chumpitazi. Chumpitazi increased Rachel’s reflux medication and put her on a milk-protein allergy diet. Appellant reported that Rachel continued to vomit and often had diarrhea. Thus, Chumpitazi put Rachel on more medications, instituted additional dietary measures, and began performing diagnostic procedures on Rachel, including endoscopies, eolonoseopies, and biopsies. These tests did not reveal a medical explanation consistent with the extent of Rachel’s symptoms, so Chumpitazi ordered more tests, including blood, stool, and allergy tests.

In April 2011, Chumpitazi was concerned about Rachel’s poor weight gain and placed a nasogastric feeding tube in her nose, which ran down her esophagus into her stomach, through which she received medicine and formula to improve her nutritional intake. Appellant continued to report that Rachel was vomiting and having diarrhea and able to tolerate very little nutritional intake except through the nasogastric tube. In November 2011, Rachel underwent surgery to have a gastronomy button and feeding tube inserted directly into her stomach to deliver nutrition. Within approximately 48 hours of the surgery, appellant reported that Rachel’s vomiting had increased. Finding these symptoms unusual and troubling, Chumpi-tazi ordered another surgery for Rachel to receive a central line catheter through a large vein in her chest that would provide an access point for the delivery of medication and “total parenteral nutrition” intravenously.2

In January 2012, in response to appellant’s report that the vomiting was continuing, Chumpitazi ordered Rachel to be fitted with a feeding tube placed directly into the stomach that extended into the small intestine to bypass the stomach. The goal with was to deliver nutrition into the small intestine, so that the vomiting would [310]*310stop. Despite these interventions, appellant still reported that Rachel was vomiting, having diarrhea, and developing fevers at home.

Over the course of Rachel’s treatment, Chumpitazi conducted extensive testing to determine a medical explanation for Rachel’s continuing symptoms, but Chumpita-zi was unable to ascertain the cause. In February 2013, Chumpitazi met with appellant and recommended that Rachel resume regular feedings in lieu of receiving nutrition intravenously and through feeding tubes because Rachel was not receiving any benefit from her treatments and the treatments put her at risk. Appellant disagreed, and Chumpitazi referred Rachel to another gastroenterologist at Texas Children’s, Eric Chiou.

Rachel was admitted to the hospital numerous times while she was seeing both Chumpitazi and Chiou. During her hospital stays, she developed infections from multiple types of bacteria introduced into her central line catheter, which Chumpitazi described as “extremely rare.”

Like Chumpitazi, Chiou could not find a medical explanation for Rachel’s symptoms. Not only were Rachel’s symptoms worsening, but Rachel was experiencing (1) sudden and inexplicable drops in her hemoglobin levels from rapidly losing large amounts of blood for which she received transfusions; (2) numerous complications with her feeding tube; (3) the aforementioned central line catheter infections; and (4) episodes of severe hypernatremia, which is a dangerously high level of sodium in the bloodstream. Rachel was hospitalized repeatedly because of these issues and underwent numerous medical treatments.

By June 2013, Chiou began to suspect medical child abuse. He met with Marcella Donaruma, a pediatrician and specialist in medical child abuse at Texas Children’s. She agreed to consult on the case. During this time, Rachel was repeatedly hospitalized. In August 2013, one day after Rachel was discharged from the hospital in a healthy condition, appellant brought Rachel to Texas Children’s emergency room with an extremely elevated sodium level. Rachel was admitted and transferred to the intensive care unit. During this hospitalization, hospital staff, working with Child Protective Services, placed Rachel in a “therapeutic separation,” whereby appellant was kept away from Rachel. Rachel quickly recovered—her sodium and blood levels stabilized, and she was able to eat solid foods and no longer needed the central line catheter or feeding tubes. Based on the results of the therapeutic separation and Donaruma’s review of the medical records, Donaruma concluded that Rachel had suffered from medical child abuse.

Appellant was charged with two felony offenses of intentionally or knowingly causing serious bodily injury to a child. After the jury found her guilty, it assessed punishment at 20 years’ confinement for each offense, to run concurrently.

Discussion

Appellant brings four issues. She challenges the legal sufficiency of the evidence in support of the jury’s guilty verdicts and complains that the trial court abused its discretion in (1) not excluding the State’s discussion in voir dire of Munchausen by proxy also known as factitious disorder by proxy, appellant’s Facebook posts offered by the State, and statements made by appellant to Rachel’s guardian ad litem; and (2) in excluding testimony from the State’s expert witness regarding an alleged prior misdiagnosis in a different case.3

[311]*311I. Jury’s Verdicts Supported by Legally Sufficient Evidence

We address first appellant’s fourth issue in which she challenges the legal sufficiency of the evidence in support of the jury’s guilty findings against her for felony injury to a child. Appellant argues there is no evidence that she administered sodium to Rachel and that, instead, Rachel (1) suffered from dehydration and not salt poisoning; (2) was misdiagnosed as having suffered medical child abuse; and (3) was “over-medicalized,” which is why she got better after she was separated from appellant and her medical treatments stopped.

When reviewing sufficiency of the evidence, we view all of the evidence in the light most favorable to the verdict and determine, based on that evidence and any reasonable inferences therefrom, whether any rational factfinder could have found the elements of the offense beyond a reasonable doubt. Gear v. State, 340 S.W.3d 743, 746 (Tex. Crim. App. 2011) (citing Jackson v. Virginia, 443 U.S. 307, 318-19, 99 S.Ct. 2781, 61 L.Ed.2d 560 (1979)).

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Cite This Page — Counsel Stack

Bluebook (online)
514 S.W.3d 305, 2016 Tex. App. LEXIS 13778, 2016 WL 7478358, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ripstra-v-state-texapp-2016.