S03 E17: Dangerous Women (Season Finale: Part 3)

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Hello, it's Andrea, and this is our final episode of season three.

This season has been a wild ride.

Thank you for joining us.

We made this season in real time.

My team has been incredible, keeping up with everything I have asked of them.

So thank you so much to the folks at Large Media, in particular, my amazing producer, Tina Knoll, and our incredible editor, Creen Kiltow, who have really been burning the midnight oil to make this season happen.

So thank you so, so much.

In the last episode, we discussed some of the significant problems with the New York Magazine piece on the Maya Kowalski case and Dr.

Sally Smith.

And I have an update.

I reached out to New York Magazine, Andy, and Neary asking for their comment with a detailed breakdown of the most egregious errors in the piece.

I heard back from the senior director of communications and she said, hello, Andrea, thank you for reaching out with your concerns.

We have reviewed them and stand by our reporting.

Before we get into the last part of our interview with Dr.

Sally Smith, a brief update on where things stand with the ongoing Kowalski case.

As we discussed with lead attorney for Johns Hopkins All Children's Ethan Shapiro,

there was a motion for a new trial based on juror misconduct.

There was a brief interview with that juror yesterday.

It did not amount to much, and the judge has dismissed their motion for a new trial.

So now the most likely outcome is that they will carry on to the appeals process.

And I will certainly update on the main feed at some point when we have news on that and on the Patreon and subscriber feeds on Apple.

Dr.

Becks and I will continue to recap the goings-on there.

And we are also going to be watching and recapping.

the Gypsy Rose Blanchard lifetime special that is airing starting today, January 5th.

So if you are interested in that, join us there to chat about that.

As you may know, Gypsy Rose Blanchard, who conspired to murder her mother, Dee Dee Blanchard, after enduring a lifetime of munchhausen by proxy abuse, was just released from prison last month.

So that has obviously been a big headline.

Join us on the subscriber feeds if you're interested in that.

And of course, that is a great way to support the show.

And I am so grateful for all of you who have left ratings and reviews of the show.

Those help so much.

If monetary support is not an option, that is really the best thing that you can do to help us keep making this show and also just spreading the word.

And on a personal note, I have gotten so many messages from you this season, and I cannot even put into words how much these mean to me.

So many of you shared your personal stories, either as healthcare workers, as family members, of survivors, as survivors.

These just make everything that we do here worth it.

And I thank you so much.

People believe their eyes.

That's something that actually is so central to this whole issue and to people that experience this: is that we do believe the people that we love when they're telling us something.

If you questioned everything that everyone told you, you couldn't make it through your day.

I'm Andrea Dunlop, and this is Nobody Should Believe Me.

Have you ever had that dream where you're standing in a room full of people and you are screaming at the top of your lungs and no one can hear you and you're just paralyzed?

In some ways, since everything that happened with Megan, my sister, 13 years ago, I feel like I have just been forever stuck in some version of that dream.

And I'm just in this

liminal space where I'm trying to sound sound the alarm and feel like I'm the only one that sees this danger and my voice is just getting like swallowed by the wind.

And then

last summer, when we were a few episodes into our second season, everything changed overnight, practically.

Suddenly, all of these people were listening.

And for me, it felt like I'd been standing in this room screaming since forever

and no one was looking at me.

And then all of a sudden, all these faces turned in my direction all at once.

You know, I'm really proud of the work that we do on this show.

And I had no idea what kind of audience this show would find when we started airing it.

I just wanted it to find the people who needed it.

So when our numbers grew exponentially over the span of a couple of weeks, you know, it was really exciting.

and I was happy about it, but it was also a little bit jarring because,

as I expected, honestly, from the beginning of making this project, not everyone is happy about what I have to say.

And this season of Nobody Should Believe Me has been really different from the first two.

I, of course, I have not experienced anything like the vitriol and threats that Dr.

Sally Smith has endured, but nonetheless, having people malign you and spew spew hatred at or about you, even if it's safely contained to the internet, is really unsettling.

And I've gotten some of that this season.

People have called me a creep.

They've called me an ableist, an opportunist, and some other things that I'm not going to repeat because my dad gets really upset when we use foul language on this show.

And I've also been accused of fear-mongering and trying to create a moral panic about medical child abuse.

And, you know, the implication there is that it doesn't exist and I'm trying to freak people out about something that's not real.

And

these criticisms are very different tenor than what I got initially, which was just the usual podcast stuff of people complaining about my voice or the number of ads in the episode.

The people who are criticizing me now are accusing me essentially of being dangerous.

And as we've learned so far about Dr.

Sally Smith, that's something that she is very familiar with.

So, so far, we've talked to her about her life and work.

And in the last episode, we covered this parade of quote false accusations that are

not

that.

Today, we get to the heart of it.

the missing piece of the story that we've been talking about all season.

What really happened to Maya?

What do you remember about getting

that first call?

I believe it was from Dr.

Tepe Sanchez.

Correct.

Well, she called me on a Saturday.

And

for 32 years, I was on call 24-7, 365, unless I was out of the country to get those calls.

So, you know, I'm talking to her on a Saturday.

Dr.

Tepa Sanchez was the pediatric critical care physician who saw Maya Kowalski when she was originally admitted at Johns Hopkins All Children's.

She was the doctor who called in the original report, which was screened out.

And at that point, she called Dr.

Sally Smith to get her advice.

So I think she probably did give me a little bit of information about the unusual treatment with the high-dose ketamine.

And I think they were concerned about not only the mother's behavior, but the child's behavior at that point and had concerns for medical child abuse and I think as I recall in terms of the conversation it was what do we do and I said well what

needs to happen is you've got to get every medical record that kid ever had and review that and see if there's enough evidence to support this.

So in the way that the system works, like our child protection team reviewed every report for Pinellas County every day to see if they met certain criteria where we needed to do a medical evaluation or not.

And what are called screened-out reports don't come through.

Oh, I see.

Okay.

And sometimes they're referenced in the next report that there was a screened-out report, but not always.

And so in this case, what I got was only the information related to what turned out to be the second report.

I had no idea that there was a first report that was screened out until much later.

There was much ado made about this being the second report.

The inference being that somehow Dr.

Tepa Sanchez called Dr.

Sally Smith and they sort of cooked up some way to make this look like child abuse.

But that's not what was happening here.

You know, medical child abuse is profoundly complicated to investigate.

And this was not Dr.

Tepa Sanchez's area of expertise.

And it was Dr.

Smith's.

So there's nothing untoward at all about her asking her for advice on how to report.

And when the second report was accepted, Dr.

Smith dug in.

In this specific case,

I clearly needed to know better

about complex regional pain syndrome and take a look at some of the preliminary records and things.

I kind of preferred to do that before I got an extensive history.

So I kind of knew what questions to ask.

So I got the

request to provide the evaluation that Monday morning.

And I looked at some of the medical records that were in there.

And hers went back a ways.

So that was actually.

She's been to Johns Hopkins All Children's quite a few times.

For

over the preceding year and a few months, 15 months, I think or so.

And so I could look at that stuff.

And then as you scroll through these medical records, you see names of of people who have seen the kid.

So there's references to Dr.

So-and-so that the child went to yesterday.

There may not be any additional mention of that person through the rest of the medical records, but it's there.

So I just started making a list of all the physician names I could find, all the hospital names I could find.

And my wonderful medical assistant at the time, I handed her the list and said, get me all the records you can.

It's a big job.

And we had a, so under Florida statute, in order to be able to do these evaluations, obviously you need to be able to review medical records.

And so this wasn't Dr.

Smith's first time with a medical child abuse investigation.

And while she's been painted as somehow having a vendetta against Beata from the chump, this was a woman she'd never so much as met.

And her initial reaction to the possibility of doing the investigation in this case was quite the opposite.

I had briefly looked in the computer when we had the conversation on the Saturday, but I was somewhat hopeful that I would not have to do the medical child abuse evaluation because it was an out-of-counted case.

And so then I'm like, okay, I guess it's me.

You wouldn't know this from watching the film, but by the time Dr.

Sally Smith met with Bianca Kowalski, the DCF investigators had already spoken with both parents.

They'd already obtained some information in terms of what was being presented as the history.

I

had some conversation with them.

The way it works in Florida is that you make the call to the hotline, and depending on the type of case, it's either an immediate response or a 24-hour response.

And so the investigators had already been out there, I think it was the Sunday, and talked to the parents.

So in Florida, law enforcement responds with

or every time?

Pretty much.

Yes.

Some not necessarily the very first time because this was an out-of-county case and they came up to the hospital.

There were some people from Pinellas County that did some stuff initially.

Anyway, but by the time that discussion took place with Beata,

law enforcement was involved.

This entire series of events, of course, was omitted from the Take Care of Maya film to fit neatly into this narrative about Dr.

Smith making snap decisions about abuse.

She never stated who she was.

She just walked in, looked at me, looked at Maya.

She came in and she acted like a regular doctor that worked for the hospital.

And she started to ask questions.

If they would have known who she was,

we would have never spoken to her.

Before this interaction with Jack Kowalski ever happened, Beada had a lengthy meeting with Dr.

Sally Smith, and she certainly knew who she was.

And we know that she told Jack about this meeting because it came up in her text messages during trial.

And there was really no mistaking the nature of this meeting with Beada and Dr.

Sally Smith.

So there were a couple of child protective investigators that were present.

There were a couple of law enforcement people that were present.

And then myself, and they kind of just listened while I and probably took notes and stuff while I got the history from her.

What do you remember about just maybe even like your impressions of her when you first met her?

You introduced yourself in a single day.

I did and told her who you were.

And that's what I mean.

The reason Dr.

Smith and I are laughing here is because this anecdote about her not introducing herself or misrepresenting who she is comes up over and over again in the media coverage of her.

And it's just not not true.

She knew exactly who I was.

There was no question that this was related to the child protective investigation.

Right.

The conversation.

What do you remember about her during that conversation?

I think, understandably, considering what had been going on for the few days, she even made reference to being tired and not getting sleep and things.

She

seemed somewhat,

I would say, like agitated or pressured somewhat to me, somewhat animated.

And,

you know, I approached the history taking in a fairly methodical manner.

And

I even put in my report that I would ask a question and perhaps there would be some realm of answering it that would occur, but there was an awful lot of other information that was thrown in and extraneous things.

And it was somewhat disjointed.

I imagine that really any parent that's in this situation, like I can, I can empathize, I think, with

if you find yourself in that situation, that would be really scary.

The stakes would feel really high.

You would feel, I mean, any parent that's in the IC with their child is going to be agitated, I would imagine, or that's pretty common.

Sure.

Knowing that,

especially in that circumstance where you have DCS investigators with you and the police, that that's going to be,

you know, that that parent could be feeling intimidated.

That could be, I mean, how do you kind of try and approach a parent to get a coherent history from them and try and just get the, like, do you try to be just sort of as neutral as possible?

Do you, I mean, it, like, what is the sort of tactical approach?

I think that it ends up working out the best if you're fairly calm, fairly, you know, straightforward.

If a person's going off on a tangent, not to really go with them, but to redirect back to

what you were trying to ask about.

I mean, in a case like this, I want to kind of get what she sees as the medical history since birth and

try to figure out: was there some point in time that something happened?

And

all of a sudden, you know, there's this much more

intense focus on medical issues.

Has this been a child who's always had serious medical issues?

And just ask a question

from before

the wandering occurred

in a calm, you know, kind of objective sounding manner, then you can sort of get people a little bit back on track.

It was fairly disjointed and

gave some information about, you know, kind of what led up to everything, but not necessarily in a real

sequential, coherent manner.

The presentation was essentially that this had all started with asthma.

Right.

And I had already looked up complex regional pain syndrome and read some articles like Monday evening or whatever.

So

that isn't a trigger for complex regional pain syndrome.

So we have asthma, and then

that's being treated, and then suddenly she can't walk.

Right.

You know, that was kind of all presented.

I mean, I think in some ways, I would, as I recall, she seemed somewhat excited about the whole ketamine coma in Mexico thing.

What do you mean by that?

I guess just

more specifically focusing on details about that and

maybe

steering the conversation somewhat into all the medical things that were wrong kind of thing.

And

the idea that this was sort of the worst case ever and she required the most intensive treatment and

you know that kind of idea.

Right.

And almost like,

and I mean, this corroborates very closely with how she describes the situation.

Exactly.

In her own words, like it's sort of grandiose, I guess, the sort of like, I'm the youngest child to ever receive this procedure.

I have the most severe case of whole body CRPS that anyone has ever seen.

Right.

And I think that, you know, beyond that, the pattern of going to specialists.

and all different specialists and everything.

I mean, as I recall, she was kind of interested in presenting all of the different doctors that had had to see Maya.

And, you know, this, again, most of your case,

you know, needed the most intensive evaluation and testing and treatment and everything.

That conversation sounds like was pretty focused on the events of like July 2015 when she had the alleged onset of CRPS on top.

Right.

I mean, I think she, as I recall, I think in once I got the records, there were exaggerations about medical history prior to May to June of 2015.

But most of our discussion was related to

when things started, which in her, you know, telling was roughly June 2015.

And then you are basically

going through the process of doing an initial record review.

So

when did you,

when did you meet Jack Kowalski and Maya?

I think it was two days later.

Okay.

That day when I talked to Beada, I did try to go in the room and that kind of thing, but

it, I mean, you know, sometimes you walk in a room, you know, it's just not an appropriate time to be trying to do a medical exam because I needed to, you know, for my medical evaluation, I needed to do an exam that's expected.

And typically we take photos and things like that, but

neither one of those things actually ever happened in this case.

So when I came back, I thought, you know, you definitely need to talk to the father as well, especially in a scenario like this that he's in the home.

And so

I

went back to the hospital a couple days later and tried to talk with him and see if I could do an exam at that point, see if I could take some photos at that point.

Again, that exam and photos part didn't take place, but I did have some conversation with Jack.

And

in some ways, it was what I would consider sort of a typical scenario in which I'm asking medical history

and

he just was responding that's Beata's area and portraying that he didn't really know anything about the medical care.

So in the film and throughout the trial, Jack Kowalski portrayed himself and his family as being victimized by the system.

And the reality is, which we've discussed this season, there are people who are very disenfranchised by the child protection system in this country.

And they are not the people who can afford to hire a battalion of attorneys to represent them in dependency court.

So, yeah, there were five attorneys.

I mean,

this was a circus from the legal standpoint, right out of the gate.

That was part of why it took so long for anything to happen was because there were hearings and motions and, you know,

Maya had an attorney, Jack had an attorney, mom had an attorney, there was a guardian enlightenment attorney, there's a dependency attorney.

And, you know, all this,

the poor judge is head spinning trying to, you know, sort through what's the best thing for this child.

And that's what the judge is trying to decide.

Right.

And, you know, listening to the evidence that's presented from the child protective investigation side and the dependency attorney and the defense attorney and the experts that the parents might have.

And, you know, all those things were going on in this case.

And the judge was hearing all this information and then trying to make some kind of a decision about what's best for the child.

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So they were preparing to go to

the shelter hearing.

I'm sorry, I think it was on the 14th because I did that report on the 13th.

And so they asked me if I could provide something in writing.

And at this point, how much of the medical records had you been able to look through?

I had received probably two-thirds to three-quarters of what I eventually got.

And I had

pulled up a bunch of articles.

and taken a look at those.

I had scanned through a fair amount of the records that I had, but there's only so many hours in the day.

So

I had a fair amount of information, but there was a lot still to review.

I had received it, but not necessarily reviewed everything.

But what I had seen to that point

was quite alarming in terms of the concern for medical child abuse.

And I think one of the things that's important in a case like this is you have to look at the potential risks for the child.

How threatened is their safety?

And if a child has an indwelling IV catheter that goes into a major blood vessel, that's a whole different ball game than a child who has no kind of access to the internal part of the body.

And if the child is getting

very unconventional, treatment that's potentially very dangerous.

That also is something that I would take into consideration at that preliminary moment.

You know, if it's a child that doesn't really have those levels of safety concern, then I might be more inclined to say, I'm still looking at the records, I'm concerned, I don't know exactly, you know, where this is going to lead.

But in this particular case, and in cases like this, where there's this high level of risk to the child, then I'm more inclined to

say

there's significant concern for risk and harm and those kinds of things in this case.

And those parents cannot provide a safe environment for her at this time.

One of the things that I came to understand more thoroughly by the time I wrote my final report

was that

Beata was an infusion nurse.

That was her

day-to-day job, putting medications through veins.

And

I think at that point, I already had seen fairly extensive indication that she was accessing that port on a routine basis.

And

I

don't think

there were multiple lists of medications, including IV forms of opiates, that I knew,

you know, were of a concern.

That she was administering at home?

Yes.

I didn't know until somewhat later how much ketamine she had access to in the home.

But anyway, so.

Not oral ketamine.

Well, that's an interesting stat as well.

Okay.

Liquid ketamine is intended for IV use, but can also be given orally.

There is not an oral form of ketamine.

So it's not like there's a pill and there's a liquid.

It's no.

Okay.

They're one and the same thing.

So

if you've got this central access and you've got this infusion nurse and you've got this liquid ketamine that can go right in that thing, or you know, other medications that are supposedly present, that takes this case to a level of danger to the child

that really changes exactly how

slowly, casually,

optimistically you might look at the medical information.

Because, you know, one of the things that people don't understand necessarily about medical child abuse is that

there's often escalation.

You know, certain things are generating attention, whether it's on the internet or from physicians or whatever it is.

But then that becomes less exciting.

And so you ratchet up the...

It's like an addiction in that way.

We have seen that pattern in every case.

It's very much like an addiction.

And so sadly, as that escalation occurs, typically there are gastrostomy tubes that end up in place.

There are central indwelling IV catheters that end up in place.

There are

other ways that the level of danger can increase because

of the equipment that's present and things and the medications that are prescribed and everything.

So it turns out that the risk of mortality for medical child abuse is 10%.

Some studies go down maybe as low as six, but that's a pretty substantial number.

And

the risk in a person, in a child who has an indwelling IV catheter, and a person who knows how to use it is not 6% or 10%.

And, you know, if the

report gets made partly related to

requested escalation of the treatment that was already fairly dangerous, then the level of risk in a case like this just

becomes

something that you can't really accept that risk that we'll just hope everything works out for the best at home.

Early on in Maya's ketamine infusion treatments that she'd been receiving, Beata had requested that she get an indwelling port.

So this is a very common element in medical child abuse cases.

Hope Yebara, who we covered in the first season, took blood out of her daughter and caused her to be severely anemic using her port.

And Brittany Phillips, who we covered in the second season, poisoned her daughter through her port.

And

this is what I think so many onlookers to this case have just missed entirely about this situation.

Immediate, potentially lethal danger that Maya was in if she had been allowed to leave the hospital in October of 2016 with Beata.

Those who have cast Dr.

Sally Smith's initial report as a rush to judgment fail to grasp that Maya may not have survived a less drastic course of action.

There is a profound cognitive dissonance for me in listening to people pick at Dr.

Smith's actions.

Whether she looked at the records before she was supposed to, she didn't.

Whether or not she ought to have included that warning from Dr.

Kirkpatrick in her report about not falsely accusing Beada of Munchausen by proxy.

And that report, of course, is something the public has never seen.

You know, and then this question of like whether she should have weighed more heavily that the Kowalski Kowalski family did receive some therapy, which was one of the things the doctor suggested they do, you know, at some point at this Eagle's Wing counseling center in Sarasota.

And

during our interview, I found myself asking Dr.

Smith about these criticisms.

because they had come up so much.

And you talk about that eagle's wing thing.

And then

it wasn't until I was actually sitting in the the room with her asking these questions that it struck me how absurd these criticisms were.

Because who cares?

The point is that Maya could have died.

To look at Maya now, she's this beautiful, active young woman.

You know, it's easy enough.

to forget that there was another way that this story could have ended.

The treatments that Maya was receiving were extraordinarily dangerous.

She'd already endured one ketamine coma treatment, plus a round of boosters in Mexico.

There were, of course, also the 55 rounds of high-dose ketamine infusions she received from Dr.

Hannah.

And in April of 2016, during the time period where Maya was supposedly doing so much better before her October 2016 relapse that brought her to Johns Hopkins, her parents were raising money to send her to Mexico for another coma treatment.

Just to remind you, this is again a procedure with a 50% chance of death.

In the blog that Beata wrote in Maya's voice, she talks about them connecting when they were in Monterey with this family and this young woman, Jessica Stevens, who was receiving this same treatment for CRPS.

Jessica Stevens was positioned by the plaintiff at trial as an example of someone who had died from CRPS.

But what Jessica Stevens actually died from was sepsis following one of her treatments for CRPS.

And

as we know from Beada's blog, she talked about Maya's death constantly, starting right around the time of her diagnosis.

And she had talked about Maya's death during that Johns Hopkins hospitalization.

She said that she would take her and put her in hospice if they let her leave without getting the ketamine treatment.

This is an option that we now know Beata had begun exploring weeks into Maya's diagnosis when she had had Maya labeled as terminal.

Why wouldn't the doctors take that seriously?

It was only months after Beata's death that Olivia Gant's mother took her home and put her in home hospice, where she starved to death in her mother's care.

The hospital suspected that there was nothing actually wrong with this little girl, but they let her leave.

So what would people be saying about Johns Hopkins if this had been the outcome?

If they had done what everyone cheering on the Kowalskis is claiming they ought to have done, which is let Maya leave with her parents.

Olivia Gant's grandparents sued the hospital for their failure to report, and they settled out of court.

And I don't know what the amount was, but I guarantee you it wasn't a quarter of a billion dollars.

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But the doctors at Johns Hopkins decided that this child's life was worth the risk.

Dr.

Smith remembers meeting Maya early in her stay.

When I saw her the first time, she was pretty heavily sedated

and was in the ICU bed, but, you know, was not really alert or oriented or anything like that.

And when I saw her the second time, she had been weaned off a number of medications and, you know, was in the course of some medical treatment at the time and that kind of thing.

In that beginning period, it wasn't like there were bruises to take pictures of or burns to take pictures of or some kind of injuries that needed photo documentation.

In her case,

as the review of the case kind of went along, the thing that maybe needed photos was the condition of her extremities.

You know, was there any visible evidence of complex regional pain syndrome or not?

You know, there had been this pattern that had been observed in the hospital.

I'd seen it in the medical records from Tampa General.

I'd seen it in the medical records from Lurie Children's, where numerous people with expertise had observed this incongruity in what she was saying.

She practically was paralyzed.

She was so weak.

She was in so much pain.

She couldn't do this.

She couldn't do that.

But then

she's 10.

You know, she didn't understand that

telling somebody she couldn't grip their finger, but then being able to grip a cookie,

the doctors are observing these things, saying, hmm, there's a lot of incongruity here.

And the whole diagnosis is focusing on this dystonia.

But it had been observed by numerous people that this was not any kind of neurological, fixed positioning of the feet, which is what's required to.

Right, dystonia doesn't come and go as

Dr.

This was clearly voluntary, maybe not intentional, but yet from a neurological standpoint, voluntary.

And so I was actually going to try to take photos of her lower extremities to show that she didn't have any visible evidence of complex regional pain syndrome and dystonia and things.

And then, yeah, she became upset.

And

I've been doing this for a long time.

I didn't see, you know, certainly not a 10-year-old child.

You don't force them to do things.

That's more traumatic than not doing that.

and um at first i kind of said oh well i'll just come back when you're sleeping but then as i'm walking out i'm like this child is the victim here i certainly don't need to be piling on

with inflicting photographs on her right we've got other evidence you know photographs aren't crucial for what i need and i i don't really think that there's any point in upsetting her with this yeah and i think there's been so much conversation with this case about the idea of her faking things.

And I'd love to know your take on that.

And I think that's an important

mindset that physicians approach any kind of conversion disorder, functional neurological disorder, other kinds of things with these incongruities is that, you know, people say they're experiencing pain.

Okay, you're experiencing pain.

In terms of, you know, does that also mean you have this diagnosis?

You know, perhaps not, but you don't, you know, you're not necessarily willfully doing all these things.

But, you know, in medical child abuse, it gets complicated as the children get older.

The little children are not participants usually, except as the victim of whatever's happening.

But as children get older, you know, there are dramatic children.

There are,

you know, scenarios where it isn't even necessarily verbalized what the preferred role or the preferred presentation is for the child to be doing in front of the doctor.

There's probably a lot of

soft

communication and

verbal cues and

ways that that parent reacts to what's happening that reinforces these things.

And so I think it becomes very difficult as they get older.

There are children who have experienced medical child abuse for a number of years.

And

as that time goes along and they get into early adulthood, they become a person that has a factitious disorder.

There was endless talk.

about CRPS during this trial.

And one of the frequent criticisms of both me and Dr.

Smith was that we just really didn't understand this complicated condition.

That,

to borrow what became Kowalski Attorney Gregory Anderson's catchphrase during this trial, that we just don't get it.

Now, I don't have access to Maya's full medical records, but you have to make some pretty big leaps of logic to believe that she legitimately has CRPS at this point because of the way that we now know this diagnosis originated.

Beata was messaging with parents of CRPS children before Maya ever received this diagnosis, and Beata reported to Dr.

Chreisman, the pulmonologist, that Maya had a positive diagnosis of CRPS

before she ever saw Dr.

Kirkpatrick, who gave her the official diagnosis.

And by the way, what we also know from those messages between Beata and the other parents is that she saw Dr.

Kirkpatrick specifically on the recommendations of those parents?

So there was so much fixation on the condition of CRPS during the trial, but this was not the only thing that Maya was being extensively treated for during this time.

Far from it.

There were all of these other things in the mix, such as her being immunodeficient and a mention of Addison's disease, and of course, the severe asthma that allegedly kicked off the CRPS symptoms.

So with the asthma, for example, as we kind of talked about earlier,

reportedly with a very serious history in Chicago before they moved to Florida.

And

when I looked, she'd never been hospitalized.

She had two ER visits.

And one of the things that's important from the asthma standpoint is that it was cough-variant asthma.

So, and the thing that she was having was a cough that was manifesting how severe her asthma was.

So, then I think this was testified to by specialists in court.

I don't think I'm saying anything out of line that multiple people said, this is a habit cough.

This is a psychogenic cough.

You know,

the pattern clearly was not related to asthma.

I mean, asthma is always worse at night.

And there were repeated observations that she didn't cough during sleep and things like that.

So, that part was

exaggerated and therefore

treated more

sort of aggressively than

might have happened otherwise because of exaggerated history.

She was taking quite a high dose of steroids.

Right.

And

you know, it was interesting in terms of

because of that history of more severe issues, the level of steroids that were to be used in a certain scenario were

higher.

And

I think it was presented in court that the one allergy immunologist, for example, had seen her and she

had a habit cough.

Her oxygen level was perfectly fine.

And yet, later that day, a large dose of steroids had been given to her, you know, by her mother's decision-making and stuff.

And, you know, it all kind of goes together.

So the habit cough, one of the things we think of with coughing is, could it be an acid reflux problem?

Well, if you can't tolerate the test for the acid reflux to see one way or the other, which is the pH probe, if you can't try it, well, maybe we'll just give an empiric trial of treatment for

acid reflux and see if it helps the cough.

Right, because there was this pattern always of Maya

allegedly being in too much pain to have this kind of test done or like the to be examined.

Right.

So, yeah.

So, that was sort of complicated getting to the bottom of any of these other things that were going on, I would imagine.

Right.

And so, then all of a sudden, oh, well, she's on this medication because she has gastroesophageal reflux.

And

she got all these steroids in July and August, and somebody did a cortisol level that was low because cortisol suppresses your adrenal gland and causes your

body's production of cortisol to be unnecessary and much lower.

And so

then that becomes adrenal insufficiency, which

these certain doctors say, oh, well, that's a feature of severe whole body complex regional pain syndrome.

Doesn't have anything to do with some medications you all just gave her, but it's causing

this adrenaline.

This is a reaction, not a symptom.

symptom okay and of course none of this was allowed in to the trial and even what narrow pieces dr smith did get to testify about mostly happened out of the earshot of the jury well and i think that the whole thing on court tv was very misleading too because it made it seem like there was a fairly balanced presentation because of the proffered questions

and indeed what the jury heard was really restricted I didn't really have the opportunity to testify to anything about my medical evaluation in court, which to me,

that's the whole case.

Yeah.

Yeah.

It's, yeah.

And, you know, all these individual people presenting their little bit of

the story.

but nobody being the one to pull it all together and make the case for

why all these things were done yeah right

the the jury didn't hear any of that so i mean i can't even imagine how they would be able to make any sort of they just got

um and so that happened i ended up somewhere in the 2500 page realm of medical records because it turned out to be um a 45 page narrative report and so i just went through in my report you know sequentially starting from

her early childhood in Chicago and the records that I had received from places that, for example, didn't show any asthma hospitalization ever.

And then I ended up making a calendar at the end for that last 15 months that

you start to realize how many medical visits there were just by

this is the calendar we this was in the police report so that we have seen this calendar and we wondered who wrote it and now so that was me um and so that was how i approached the report in this was i um had reviewed this crazy stack of records and i also had reviewed a lot of the medical literature because i need to be able to speak intelligently about whether there was complex regional pain syndrome or not.

No, I'm not an expert in that.

But the literature is fairly spelled out about what this is, how you diagnose it, what you treat it with.

I mean, I was looking at things right up to the, you know, 2016 timeframe, trying to find what's current treatment, is this current treatment.

So, you know, I had done all those things and then did the calendar to give some almost visual to that.

process of right because you have to make this digestible for the courts for dcf for the police you can't just i mean honestly probably most of them didn't read the whole four or five pages, but the calendar was probably somewhat illustrative and then the conclusion.

And so,

so anyway, that that was sort of the process.

And then trying to then put this all together.

So, you know, I got

full-time jobs

while I'm trying to do this.

I mean, I spend a lot of time on the weekends, in the evenings, working on this.

So, anyway, I mean, it was finally finally early December before I

just had to finish it and get it done and, you know, get the report out there and things like that.

So.

So, okay, so you submitted your report in December and then

not too long after this,

then was

Beata's death.

Correct.

Do you remember hearing about her death?

Yes.

And who told you?

The DCF attorney that I had been, you know, kind of working with to help with their dependency case.

And how did that information land on you?

Honestly, my mind was kind of blown.

I mean, I've never had,

I had

evaluated,

you know, I would say between 20 and 30, over 30 years, cases of

medical child abuse and had some

recognition that the mental health issues of the perpetrator put them at some risk for suicide, but it's very small, maybe 1% or something like that.

So it wasn't like I had never considered that as a possibility, but

certainly did not expect that to be the outcome

in this particular case.

Beata had been the main subject of the investigation, and all of the data that we have about medical child abuse points to a very high proportion of female perpetrators.

But by the time Dr.

Sally Smith had finished looking at all of the records she'd collected on Maya, she'd really begun to question Jack's initial presentation of himself as the dad that was just pretty clueless about his daughter's medical care.

Since he had been the parent who took her to,

I think, at least half of these unconventional treatments.

I mean, I didn't really know what the dynamic was there and what

his level of complicity might be and, you know, that kind of thing.

And

also that, you know, in many cases of medical child abuse, it really is just the mother, or in rare cases, it really is just the father.

And so the other parent may be a reasonable alternative for a safe home.

I walked away from what I looked at, having no idea if she would be safe

with Jack instead,

you know, because of

just the whole pattern.

Ultimately, the courts did end up sending Maya home with Jack following Beada's death against the recommendations of Johns Hopkins All Children's.

And Dr.

Sally Smith, as was her way, carried on.

You know, it was tragic.

This thing was tragic from way before her death, but, you know, but in terms of getting too caught up in it, I literally put the binders together, you know, put the box of records over somewhere and moved on with the next case to a certain extent.

And I don't mean that in a

callous or cavalier way or anything like that.

It just, it is what it is.

I mean,

yeah, I mean, I have that ability to maintain boundaries and things.

And so, you know, I certainly wasn't in any way trying to be unfeeling about it or anything, but this had been a scenario that was consuming a tremendous amount of my time and energy and emotional energy and everything.

And,

you know, it just stopped.

And

so

I kind of moved on.

That was the last that Dr.

Sally Smith heard of the case until the summer of 2018, when she got a very colorful letter from Gregory Anderson, who is requesting all of the records.

And honestly, my initial reaction then was:

okay, well, you know, bring it.

I got a 45-page report.

I got thousands of pages of records that I reviewed.

Sure.

You know, if you want to talk about whether or not this is medical child abuse, you know, let's talk.

But,

you know, obviously thousands of motions and hearings and all of it later.

I mean, the whole thing, the circus continued and still does, obviously.

Once the media got a hold of it, Dr.

Smith was immediately cast as the villain.

And, you know, she's got that resting bitch face that she discussed.

And she had settled out of court with the Kowalskis.

And that's something that...

gives the appearance of her having done something wrong.

So what's been reported is that you settled out of court with Ikwalski's for $2.5 million.

I believe that.

That has been extensively reported.

What

actually happened?

What actually happened is that

the original lawsuit did not include the Department of Health of the state of Florida, even though they were my primary employer.

And even though, under the way that my compensation from the state was structured, I got additional compensation compared to some other medical directors because of the number

of out-of-county cases I did by that referral process to all children.

So

by all rights,

the person who should have been sued related to me was the Department of Health.

Like the person who should have been sued as your employer.

Exactly would have been the Department of Health.

But I mean, I think I can safely say that Mr.

Anderson knows about sovereign sovereign immunity.

And there are serious limitations on what compensation can be obtained from the state related to conduct, especially when a person is acting in good faith.

So

they were not named in the suit.

They

chose to take the position that they couldn't really get involved because they weren't named in the suit.

They would kind of help me a bit, but

you know, such as such is the legal world or whatever.

And so it fell on this local agency called Suncoast Center, Incorporated.

Suncoast had held the contract for the child protection team as just a small part of their,

it's a counseling, mental health.

Community-based care organization.

Nonprofit primarily, you know, agency.

So they had the contract for the child protection team for

12 years or something like that when this case came along.

And, you know, it's a small agency.

They had insurance, obviously,

that covered all their staff, including their medical providers.

And so, it's a small agency with a relatively small insurance company kind of thing.

And

at the point that

this went to mediation in

December of

21.

I believe that's correct.

And

just from an actuarial insurance company standpoint, somebody had died.

That was going to potentially be a sympathetic factor for a jury if this went to a jury.

They just looked at it at an actuarial table and said, I'm not, you know,

we don't know which way this could go if it goes to trial.

And I think at that point, the attorney

told me that

all the time that he had put into the case as the attorney had summed up to $800,000 already.

And so there was an expectation this was not going to go to court.

for at least another year, possibly longer.

And at that point, there'd already been hundreds and hundreds of motions and counter motions and hearings and all and depositions.

My deposition for this case was video deposition for a cumulative of 26 hours.

And, you know, there were probably others that were at least four to six hours, like all-day depositions, probably 100 or more of these that had been going on.

So they had they had put in all this money.

They looked at the limit.

Their insurance limit was $3 million.

It was purely a business decision.

This was going to cost them at least another $800,000 to $1 million to take it to trial.

And then there was a possibility that it would.

And I mean, I was frankly very upset.

I felt like I didn't do anything wrong.

This was going to get out into the media as soon as it, and exactly what happened.

Oh, don't worry.

It will be confidential.

We're talking about Greg Anderson.

This is not going to stay confidential.

Seriously.

I mean, you know, it was a matter of weeks before

the fact that this had been settled was out there.

So

this was not your choice.

And it was not the action you wanted to do.

You seriously considered refusing to sign the settlement agreement.

And there was a clause they put in that this settlement didn't indicate that I had, you know, admitted any wrongdoing.

Well, of course.

And then people, well, you must have done something horrible.

Why would they have settled for two two and a half million dollars?

Well, that's what insurance companies do.

I was an employee.

I didn't have any choice as to whether I signed it or not.

Right.

I,

you know, tried to argue a little bit.

But I mean, honestly, within a couple of months, I decided I was going to resign.

Because you felt like, wow, it came down to it.

And my employer just didn't.

have my back.

I mean, or that was part of the realized kind of how vulnerable you were.

The state of Florida didn't have my back and the statewide child abuse pediatrics medical director tried the best that she could, but there was just nothing.

Yeah, nobody seemed able to figure out any way to have my back.

And, you know, I mean,

I always thought under Florida statute that if I was acting in good faith, there was sovereign immunity.

I certainly would never have any liability for having done a child abuse medical evaluation.

If I

had a 45-page report with 18 pages of calendar and multiple pages of growth chart, and

that's what I had done, that I certainly would never be thought.

You can show your work, you have the receipts, committing malpractice or some kind of medical negligence or something like that.

And this case just turned that completely on its head.

Somehow, I have personal liability of some sort when I did my job.

And that's the real rub of this whole case.

The bargain that doctors thought they had in doing their duty has just been obliterated.

Dr.

Smith did not end up here because she did something wrong.

She's here because the rules changed in the middle of the game.

And insurance companies, as she said, they do the math.

And here's what that math looks like now.

In December of 2023, a Florida state jury found that DCF had been negligent in their failure to properly investigate an abusive head trauma case involving an eight-year-old girl.

This child had sustained injuries from this abuse that left her with quadriplegia and severe brain damage for which she will require intensive care for the rest of her life.

The jury in this case awarded her $15 million.

That's 5.7% of the Kowalski settlement.

As much as there is, I know from being involved with this, so much disbelief and disinformation about medical child abuse cases, there's also a huge growing pushback about the existence of abusive head trauma, despite the consensus among medical professionals about it, which is 95% since we're doing math today.

And the other cases in the film all concern abusive head trauma.

And so does the next one, Coming Down the Pike at Sally Smith.

And so

I just looked at, this isn't going to be the first case.

And Greg Anderson's got another one in the wings, as he said, to finish my career.

I mean, he actually put that in a letter to my attorney.

The case that she's referring to here is the case of Elena and Vadim Kushnier.

So this is another case where a family is claiming to have been falsely accused of child abuse and another case that involves both Gregory Anderson and Johns Hopkins, all children.

This is a very complicated story and we are going to cover it in a future episode.

So then when the Kowalski case finally went to court, Dr.

Sally Smith thought she might get her chance at last to tell the truth about what happened.

And unlike Dr.

Kirkpatrick, who famously left his notes at the hotel, Dr.

Smith came prepared.

So, Sally, can you tell us what is in this stack of multicolored binders that is sitting in the chair next to Sally Smith during our interview was a gigantic stack of four-inch thick multicolored binders.

And these had also made an appearance in the courtroom and um so

i i had gotten some indication from

uh the attorney that was from the insurance company from before that was working with me a little bit that my report was not going to be allowed to be entered into evidence and um but i i didn't

understand walking into the courtroom that I wasn't going to be allowed to talk about any of it.

And they were going to ask me a bunch of questions that, you know, I hadn't really prepped for in terms of whether or not I was an agent of all children's hospital.

That was the only thing that I really testified about before the jury

kind of blew my mind.

I mean, going into court, so I would say over 32 years plus a couple of years in New Jersey and my training in my fellowship, you know, I've seen somewhere between 2,500 and 3,000 child abuse neglect cases.

And,

you know, general ballpark, about 10% of those end up in some kind of legal thing where you either give a deposition or you go to court.

So I've been to court two or 300 times.

So walking into a courtroom doesn't give me any anxiety or anything like that.

I already knew, which from a pediatrician standpoint and even a mother's standpoint, I already knew that those two poor children had been sitting there listening to that whole thing the whole time.

So

it certainly adds a little element of taking some care exactly how you say things in front of them because they're children and they've already been traumatized a lot.

And apparently they're going to continue to be traumatized for another few years.

So, you know,

I wasn't,

going into a courtroom doesn't make me nervous anymore.

You know, you mentioned Maya and Kyle, and I wonder,

like,

if you could say something to Maya specifically,

especially after watching how this has played out, because I've had that same thought of just like,

just

what they've been dragged through and having their entire teenage lives really dominated by this lawsuit and the film and reliving the worst moments of their life over and over again and having to listen to that 911 call over and over again.

I mean, what do you

like?

What do you hope for Maya and Kyle going forward?

And like, what would you want to say to Maya?

I think that

regardless of exactly

where things stand now about factitious disorder, malingering, or, you know, whatever things, you know, one might think about for a 17-year-old girl.

This all started when she was nine.

And Kyle was seven.

This has been going on like more than half of his life.

Regardless of whether she has factitious disorder or a conversion disorder or complex regional pain syndrome and whether that is actually whole body or whatever.

As a physician, as a pediatrician, the thing that she needs most,

no matter what it is, is intensive psychotherapy.

Because

how could she possibly not have significant post-traumatic stress disorder?

Even if this is some sort of lifelong medical disorder that she is going to be contending with,

figuring out how to manage a long-term chronic illness is really requires, or, you know, I think especially in this case,

requires

an intensive level of psychotherapy.

You know, the idea that she really hasn't gotten much of any of that over these last five years,

I mean, as a mom, kind of breaks my heart.

And Kyle, he's been kind of the invisible kid this whole time.

I feel like both of those children have are at high risk.

And

to kind of ignore that, the adults in the room,

what?

Because

if they're getting therapy, that might mean they don't need this big lawsuit.

I just,

I don't get it.

And, you know, I think that,

especially nowadays with social media.

And I mean, I have lots of teenagers that I see in my practice and levels of anxiety among teenagers now are very high.

You know, especially for girls, the whole online world is treacherous.

So, you know, trying to

get some sort of mental health intervention for her and her brother, I think,

you know, that would be the one thing

I would kind of plead with her to consider is

trying to get some help with some of that stuff.

You know, this is going to keep going on.

It's not over.

And

they've been through a lot.

Yeah.

And neither of them chose this.

Correct.

Yeah.

After we wrapped up our interview with Dr.

Smith, my producer Tina Noel, Dr.

Becks, and I walked out of her house in almost complete silence,

very rare for the three of us, and got in the car to go to the airport.

Okay, I have to say, like, I

going in, I mean, and I don't even realize, like, I wouldn't have even articulated this before we talked to her, but I was expecting her to be like

a little harsh or like a little

arrogant.

Like, I don't think that would have made her anything that people have said she is, but like,

I guess I just wasn't expecting her to be so nice and just like not bitter.

I mean, I think she's justifiably angry about the specifics of what happened, but like the way she talked about Maya and Kyle,

she clearly is able to sort of put them aside from the rest of this situation.

And I don't know.

I just

really sort of do chalk it up to this Midwestern kind of

strength.

Like she has a fortitude, yeah, strength about her that is required to do the work as as deeply and thoughtfully as she does.

I think it's like

the further I've gone along, I've had this deepening sense that your critiques of her have been so off-base and then it was just like,

you know, but I think I just, because it's been so intense, like you sort of figure like, well, there's, there's got to be something to this, right?

There's something,

you know, whatever.

It's not like no doctor ever does anything wrong or like is arrogant and like pushes, you know, and it's just like, I just didn't see any evidence.

I didn't see any evidence of that in the documentation.

And that doesn't match with the person that we just talked to.

I mean, there's been, as I've gone back and forth, I always wanted to do this interview.

I was always interested in it.

And as I've seen what the conversation

around

her has been like over the course of this trial, especially, and as the conversation about me has taken a turn over the course of this trial, there are now, and I don't look for it, but people like occasionally report it to me of like, wow, you're really getting attacked online.

And I'm like, okay, like it just, I am sort of like, have become more conscious of the fact that like I have a bigger audience.

And I have started to worry, like, I feel like, like, what is going to happen to me?

when I air this with her because I have a feeling that at the end of this, I'm going to feel very supportive of her and like she's been wrongly maligned.

And now actually, after talking to her, I don't fear that anymore.

I still think it'll happen, but I don't care because I

feel very certain that

that is the right thing to do and that that is the truth.

And it doesn't need any embellishment.

It doesn't need my opinion.

It doesn't need my bias.

It just is what it is.

You know?

Yep.

I don't think that most people,

frankly, could endure what Dr.

Sally Smith has been through over the last few years.

And

she struck me as incredibly resilient because she's always understood the importance of her work.

And no one sees this more clearly than her son, Patrick.

It's,

I think that's why she's so sort of solemn when she does this work is that she sees it as like sort of a,

I'm not religious, but like, I think a, you know, a sort of a higher calling to do it,

knowing that it's the right thing to do, even if you have to face like a horrible trial.

You know, I mean that in the sense of the trials of life, not a legal trial.

But

yeah, she

is through to her core,

has

understands why this this family has felt the way that they do,

but that

it still was the right thing to do.

One final question

is looking back on your career, like what are you most proud of?

You know, it's funny.

I kind of grew up in a in a family where being prideful was discouraged.

So, you know, when people ask me that, I struggle a little bit.

Maybe the best way for me to look at it is in terms of what I value about what I've done in my life.

I mean, I've I know I've helped a lot of children with both hats on.

So in my general pediatric practice, you know, I have a lot of families that I've helped a lot and helped those kids get as healthy as they can be and that kind of thing.

In terms of the child abuse, I ended up helping children get to safe places.

Sadly, not always.

Sometimes, despite my best efforts,

they were injured again or things like that.

But

I think even though

it was a long day often and it was a stressful job.

I think

I

brought

some good work to the table of my community and

the children in Florida.

Even though it

was difficult in many ways, I would do it all again.

If we have a maker that we go to or something,

I have no problem with

sort of

what was my life and

did I,

you know,

leave it better than I found it or that kind of idea.

Well, I wanted to say to you

that I have spent the last several months on an obsessive deep dive about this case.

And

I believe

that you saved Maya Kowalski's life.

I think a case could be made.

Yes.

But I know that.

Anyone who listens to me is going to know that.

So.

I appreciate that.

I really wanted to look you in the eye and say that.

I appreciate that.

All right.

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Coach, the energy out there felt different.

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We are working hard to bring you the next full season of Nobody Should Believe Me.

This is the story of Jordan Hope, a survivor whose voice you have heard on this podcast before.

It is an incredible story of resilience in the face of really

all of the hardships that you could throw at a child.

And I am so honored to be able to help them share their story.

In the meantime, We are going to be bringing you some updates from guests from past seasons, some updates on the Kowalski trial as it continues to play out, and other extra things.

So keep an eye on the feed for those.

Thank you so much to the entire team at Large Media, our senior producer Tina Noll, our editor Karim Kiltow, also our incredible sound engineers Jeff Gall and Sean Simmons, and Maria Palaologus, who keeps all of the trains running on time around here.

Also wanted to include a special shout out to our secret Florida doctor friend, Dr.

Becks, who not only contributed to the show this season, but also helped with a lot of the research.

And a big shout out to Jess Kramer, who helped with the research as well.