Sunday, January 29, 2006

What do you think?

I just saw Dateline NBC . The story is about a mother who was tried for murder of her 11 year old child with Type I diabetes. Her daughter had been diabetic since she was 3 and died of DKA. I was just wondering if anyone else saw this and has an opinion of if the mother should be convicted of murder, neglect, or nothing? If you didn't see the show, you can click on the link above.

So, what do you think?

25 comments:

Sandra Miller said...

I didn't see the show, but just read the transcript.

It's hard to imagine an 11-year old child's A1c getting that high -- 15, just a year before she died, then 16.1 when she was brought in -- while receiving insulin.

That's just insane.

I don't know. The whole thing is just really upsetting. To think that a child could become that sick after living with this disease for eight years.

It's hard to believe this girl just suddenly became ill and died.

Really, really sad.

bingsy said...

I didn't see it, but I was curious about the distinctions between murder, manslaughter, and negligent homicide. I found simple definitions on wikipedia: http://en.wikipedia.org/wiki/Murder.

Penny Ratzlaff said...

Chrissy, I told Michael they would have an easier time convicting her of negligent homicide. But, she was convicted of 2nd degree murder which was later thrown out.

Sandra, It is very sad indeed. I can see someone having an a1C that high and then getting it under control somewhat. But, a little over a year later her A1C was even higher? If she were getting somewhat proper care I don't think that would be the case. I think the mother had a very strong case of denial.

Jess said...

Is it inappropriate, though, to ask why the girl didn't (or wasn't) testing herself? She did have the same teaching sessions her Mom did.
I'm looking for clarification, I'm not blaming the victim.

Major Bedhead said...

It's not unreasonable to expect an 11-year old to test themselves. However, if the mother didn't regularly test and didn't see the importance of checking her daughter multiple times a day, then the daughter wouldn't think it was important, either.

I think murder was too strong a charge, but there was definitely neglect. It really pissed me off that the father got off scot free on this. He lived in the same town and saw the girl a few weeks before her death. He thought she looked ill, but didn't take her home to get her meter or bother to take her to the doctor's himself.

Also, why didn't the doctors call DSS about this? If she'd had an a1C that was that high for that long, doesn't it fall on the doctor's shoulders to do something about this? The mother certainly is NOT blameless in this, at all, but I do feel that others have to bear some responsibility for this.

It made me sick to my stomach when she said she felt no responsibility for her daughter's death. I feel responsible if my daughter has one high reading. If she DIED??! I'd be a fucking MESS, put-in-the-loony-bin crazy with guilt and grief.

Anonymous said...

To every parent of a child with diabetes in the "OC", would you ever think that you would find yourself in this woman's predicament? I don't think so from what I read in your blogs! You all seem to agonize over every high and every low. You call the Dr. when things are not right. I know that I did. There is definite negligance here. You all seem to know the state of your children's health because you are so very invloved. This woman and her husband apparently were not. I watched the program and I kept shaking my head thinking that she was so very negligent and I couldn't muster up any sympathy for either her or her husband. I cried for that poor little girl who shouldn't have died. Tragic and senseless. The technology to keep her healthy was there..the parents were not!!!

Unknown said...

I've talked to one of my son's school nurses, and her son is 15 and was DXd when he was 6, and his A1c was 14, because he just thought it wasn't that important to take his shot after he had lunch, that spending time with his friends was more important. The nurse addressed the situation with (we have the same endo) including the endo to point out what would happen to him if he didn't get his Diabetes under control.At 11, I would think the mother would be helping by monitoring her daughter's self-management and helping her. I agree it's a team effort,including the endo.
This isn't a good example, but with my healthy 11 yrold daughter, It's such a hard thing for her to do to clean her room...yet I have to remind her over and over again...It is a really sad situation!

Allison said...

No child with diabetes should ever die from this disease. EVER.

I can't stress enough that people with diabetes can live YEARS with diabetes if taken care of properly. What mother in their right mind would let an 11-year-old have control over their healthcare? Hello? My mother didn't let me WALK TO SCHOOL when I was 11, let alone take care of my diabetes. A teenager, yes, can/does/shold have a lot of control over their health because they are testing the waters as far as independence. Hello- it's illegal for an 11-year-old to stay home from alone, you're going to give them the independence to take care of a life-or-death situation? Are you nuts?

Yes, the daughter COULD have tested herself, but did she even know how to? Did she know anything about her diabetes? She was sick for a long time, which leads me to believe that Ariel really didn't know what was going on.

Shame on everyone associated with that child for letting her go unnoticed. Everyone was negligent. Children are our responsibiliy as a society.

As someone who has actually *felt* a 420 mg/dl... I feel nauseated just thinking about this.

Penny Ratzlaff said...

I agree that other people could have gotten involved in her care, but the ultimate responsibility falls to the parents. Notice I said parents. I agree that the dad was clueless too, for whatever reason.

Julia, It made me sick too to hear her say that she is does not feel at all responsible for her daughter's death. That says A LOT about that mom.

prayergal said...

I saw the show and I was appalled when the mother said she felt no responsibiltiy for her daughter's death. If our parents aren't responsible for us when we are children, who is? The father made me sick blaming the mother, he was just as responsible as she was. He had her over for a Super Bowl party and he could and should have checked her blood sugar if she was eating at his house and I am sure she was at a Super Bowl party. I just wonder if the parents being so involved in their own lives was the reason this little girl was neglected to the point of death. Not checking her blood sugar was the same as not giving her any medicine had she been sick and they had the meds there to treat her but just didn't do it. I also wondered why someone didn't report their suspicions about the mother's neglecting to check her blood sugar or giving her insulin when she needed it the year before. If the child had come to the nurse with obvious bruises wouldn't that have been reported. It is so sad that the little girl lost her life so young, you have to wonder who really cared about her.

bingsy said...

It's so weird because this is the 2nd time in less than 5 days that I have been reminded of a student I had that was being medically neglected. The Department of Human Services must have received 10 calls from various personnel at the school - we did this on purpose thinking it would get a faster response in a bogged down system. In fact, we didn't need to worry about that particular aspect because medical neglect is evidentally a high priority requiring them to immediately look into it. The child was removed at once. Her illness was so evident to the school personnel. I wonder about this particular child's symptoms at school. I think there are some extremely undereducated, mislead people out there that are not aware of the benefits of medicine and their duties as a parent in this matter. I've worked with a lot of parents that were like this. They lacked a curiousity and common sense. They don't think about what is happening and how it might be helped. They just subsist. You'd be surprised at how many, and you'd be surprised at how ineffective doctors can be - if parents do take them. I can think of two cases where I finally convinced a parent to take a child and the doctor blew them off.

Kassie said...

Some great points in the comments here.

I read the transcript and I believe it said that her A1c was 15 a little over a year before she died.

So that meant, at the age of 9, her diabetes was completely out of control.

My son will be 9 in April. I can't imagine giving him the level of responsibility that the defense tried to put on this kid.

A parent paying attention would have done everything possible. If the parents had been unable to control her despite their 'best efforts', the defense would have been able to call to the stand the kid's endo, CDE, school counselors, what have you, to testify that the kid was completely noncompliant. I didn't hear about any such testimony.

Just a mom claiming she did the best she could. It may have been her best, but it clearly was no where near enough.

Penny Ratzlaff said...

I know enough of the story to make an informed decision. I think the parents were negligent. The girl was not 13 like the girl you quoted, but 11. And, like Kassie said, the girl's sugars were out of control at the age of 9. If the mother didn't know enough about diabetes then that is her fault. Do you know how many books I've read about Type I diabetes over the last 3 1/2 months? No, I think the resources were there for her, but she didn't care to use them. As far as letting a CDE testify that had seen her 18 months earlier, I think it's because that was her last endo. appointment. They had already established that she had insurance. Riley goes to the endo. every 3 months. That girl hadn't been in 18 months. And when she did go, the mom had "lost" her glucose machine. Come on, you can get those FREE anytime. Riley has 3 and I haven't paid for any of them. I know that kids with very informed parents that are involved in their care can still die from DKA. A death due to circumstances beyond your control and a death due to negligence are two totally different things. It was established that this girl had very high blood sugars for at least 18 months. If the mom wanted to prove otherwise she should have taken her to the endo more often.

I, unlike some others, do feel a little sorry for the parents. I have no doubt that they loved Ariel. I don't think the mother intentionally killed her, but I do think that her neglect led to the girl's death. You know, if you are driving and maybe talking on the cell phone and not really paying attention to what you're doing and run over and kill a child, even though you didn't mean to do it, you will probably go to jail for a while. I believe that's what this mom and dad are gulity of. Not really paying attention.

I'm curious to know how you feel about the mother's comments that she doesn't feel responsible for her child's death in any way. If , God help me, Riley were to die from DKA after I took him to the hospital immediatly after he vomited the very first time, I would still feel responsible.

I can understand where you are coming from too. Everyone is entitled to their opinion. That is exactly why there are 12 people on a jury and not 1 or 2.

Nicole P said...

Ellen,

One reason your comparison doesn't work is that this girl's A1Cs were in the teens for over two years. I've read at least three articles that quote court transcripts that say as much. They were "off the charts" when she lived in Colorado (in 2003), right on through to when she died. The girl you've quoted says that "last fall" something happened and that she was hospitalized in October... That's no more than two months of high bloodsugars -- and, clearly, her parents rushed her to the hospital a the first sign of something wrong. Also -- if she's testifying to all of this in the past tense, the family made sure that she got what she needed to take better care of herself -- mentally and physically.

That's not what happened in Cheryl Botzet's case. Not at all. In fact, the mother said she didn't take her daughter to the Quickcare center until "Ariel couldn't throw up anymore." This, even after SEVERAL experts testified that she'd been told that her daughter should be brought to the doctor or that the doctor should be called if her daughter *ever* started throwing up.

To me, this woman had a funny way of showing her daughter love. I think she was self-absorbed and I think it's disgusting. I hope she's convicted when she's retried.

Kassie said...

I feel like I have a split personality on this issue. Pretty much every argument makes sense to me.

I've heard many stories these past few days of people - mostly women reminiscing about their teen years - fooling their parents. Lauren's story is a more current example.

If Lauren had died from that episode, though, and her mom was put on trial, I think you would have seen a much stronger defense. Endo visits, A1c's, insulin purchases, strip purchases... I think it would have been a much clearer case of noncompliance on the child's part. I know the Stanford's though (not well, but well enough) and from the get-go I would give them the benefit of the doubt in a case like this.

Which brings me around to the issue of resources. Clearly, Moira has the resources - personal strength, parenting skills, etc - to raise a child with diabetes. Even then, her child is at risk. But much less so than Ariel was, I think.

In truth, though, who knows. Who knows what was going on in that house.

I am grateful, however, for my own mom, right now.

Penny Ratzlaff said...

Ellen, I don't know where the whole "praying for a cure" thing came from. I don't think it has anything to do with this case, but since you brought it up, I'll respond. There is nothing wrong with praying for a cure. I do it every day. There is something wrong with not giving your child adequate health care to the best of your ability. As far as I'm concerned that's what it all comes down to. There are several cases of children dying from diabetes because the parents refused medical care and decided that God would intervene. These people aren't religous. They are delusional.

Penny Ratzlaff said...
This comment has been removed by a blog administrator.
Penny Ratzlaff said...

I agree to disagree. Now, we agree on something.

Did you know that if you write AGREE enough, it starts to look funny? :-)

Anonymous said...

Doctor says woman instructed in daughter's care
Murder charged in death of diabetic girl, 11
By Matt Pordum
LAS VEGAS SUN

A doctor testified on Thursday that he had thoroughly instructed a mother accused of murder in the Feb. 9 death of her diabetic 11-year-old girl on how to monitor her daughter's disease so it would never become life-threatening.

Dr. Allan Rice, a pediatric endocrinologist, said that if Cheryl Botzet would have more closely monitored her daughter's insulin levels and looked for symptoms he warned her about, Ariel Botzet might have never contracted the fatal condition of diabetic ketocidosis.

Police and prosecutors allege Cheryl Botzet neglected the monitoring of Ariel's insulin levels over a period of time, which led to her death. Under Nevada law a murder can be levied if a child dies as result of parental abuse or neglect.

The testimony was part of a preliminary hearing to determine whether Botzet will stand trial on the charges.

Diabetic ketocidosis is a condition involving an acidifying of the blood caused by a lack of insulin. Rice said the condition can be mistaken for a cold or flu, but as a parent of a diabetic daughter, Botzet was told how to respond if Ariel became ill.

Rice's testimony Thursday supported the findings of Ariel's autopsy. The coroner ruled that the girl's death was caused by chronic medical neglect.

"Parents are supposed to make sure the blood sugar levels are down," Rice said. "Adolescents become less responsible for their (insulin) shots and checking (blood sugar) levels for the same reason they can't vote, drive or join the Army. They (adolescents) are not responsible."

Rice said Botzet should have checked Ariel's insulin and ketones levels as his office had instructed her.

Ketones are chemical byproducts formed when the body is forced to convert fat into energy rather than carbohydrates. That happens when there is a shortage of insulin available to break down the carbohydrates. Ketones, ordinarily cleansed from the blood by insulin, build up and poison the body creating symptoms that are often compared to the flu.

Rice testified that Botzet never called to tell him about the flu-like symptoms Ariel was experiencing on Feb. 6, but instead called to ask for a refill of insulin. Rice said it wasn't until his assistant called to inform Botzet the prescription had been filled that his office was informed that Ariel had been taken to the emergency room at UMC.

Rice said juvenile diabetes is "normally not a fatal disease" and if "monitored correctly a juvenile diabetic can lead a normal life." He said out of the 1,000 juvenile diabetes patients he has cared for in his career, only two have died.

"It's fatal if they don't take insulin," Rice said. "(Juvenile diabetes) is fatal if (the child) doesn't monitor it properly."

Rice also said Botzet failed to have a hemoglobin A1c test performed on Ariel as requested. The test measures the amount of glucose that has stuck to red blood cells over a period of time, which can show how well blood sugar was controlled in the previous two to three months.

Rice said by performing this test every three months DKA can be prevented. Rice said that the results of Ariel's A1c test -- which wasn't administered until she was in the emergency room -- revealed Ariel was getting "less than two shots (of insulin) a day."

Botzet's attorney, Herb Sachs, pressed Rice on cross-examination as to what determined chronic neglect.

Rice admitted under Sachs' questioning that stress, fear and diet can all cause a person's blood sugar to be high. Rice testified it was possible for a person to receive insulin as prescribed and still have high blood sugar because of such factors.

Sachs asked Rice to define in his opinion what chronic neglect would be in the case of a parent of a child with juvenile diabetes. Rice said it would be "inappropriate and dangerous" if a parent in charge of a diabetic child didn't give the child insulin.

When Sachs asked Rice if he would say chronic neglect existed if a parent gave the child three shots of insulin instead of the recommended four, Rice said while not "ideal" doing so "doesn't put a child in danger."

Sachs also asked Rice if Ariel's school should be held partly responsible for Ariel's condition since they are required to monitor those children with juvenile diabetes.

Rice said schools aren't allowed to administer insulin shots, but instead are required to call the parent to pick the child up and perform treatment at home. If a school can't contact the parent it is supposed to contact the physician.

Robert Lynn, a nurse practioner in Rice's office, testified Ariel's school did make the proper calls to the office.

Lynn said he became concerned after getting phone calls from a nurse at Laura Dearing Elementary School, where Ariel was a student, indicating Ariel was getting "inconsistent" care from Botzet. He set up several follow-up appointments with Botzet but she allegedly canceled them.

Clark County school records show Ariel was absent from school 26 times between December 2002 and July 2003. She was absent 17 times in the 2003-2004 school year.

According to Botzet's arrest report Botzet told the school nurse that she was managing Ariel's illness at home and didn't want the girl's blood sugar levels to be tested, the report says. The nurse began having Ariel come to the nurse's office to test her blood sugar levels.

The logs from the nurse's office show that during the 2002-2003 school year, if Ariel's blood-sugar levels were too high, Botzet would come to school to give her a shot, the police report says.

But through that school year and into the next, the report says, Botzet stopped coming to the school altogether. By October 2003, each time Ariel called to tell her that her blood-sugar was too high, Botzet allegedly told her to drink water, do some exercises and return to class.

Testimony in Botzet's preliminary hearing is scheduled to continue today.

Seriously. Does it really sound like this woman was uninformed? To me it sounds like she was self-absorbed...

Penny Ratzlaff said...

Thank you "anonymous". That was a very informative article.

Anonymous said...

Dr Rice sounds typical medical, probably talked never listened to the mum, I've had doctors AND nurses like that, called me non compliant, wouldn't live through my teen years if I didn't listen to them, guess what, we didn't listen, and I'm healthy because we knew better then them!

Penny Ratzlaff said...

In response to whether this mother was taught or not. Ariel lived for 6 years with this disease before her A1Cs were reported as high. Do you think the mother was just "winging it" for the first 6 years? I think the mother became tired of caring for a daughter that required way more time than what she wanted to give. I think she quit trying. Even the school said she quit coming to give her injections at school. She was coming to give the injections before. She just stopped coming. This proves she knew Ariel needed the shots if her sugar was high, but she didn't go give them.

Penny Ratzlaff said...

This is from CNN's website.


The nurse practitioner who worked with Ariel's pediatric endocrinologist testified that he instructed Botzet about the steps to take if the girl showed any signs of abnormal blood-sugar levels or nausea.

"The nausea and the vomiting is serious. The first time there is a vomit, take the blood-sugar immediately," Robert Lynn said he instructed Botzet when she brought Ariel for an examination with Dr. Alan Rice. If the vomiting continued, he told Botzet, "You should call us right away and let us know what's going on."

Prosecutors allege that Ariel vomited 15 to 20 times for up to three days before her mother sought medical care.

Dr. Richard Sterett, the emergency room doctor who cared for Ariel after she lost consciousness, confirmed that he heard from another doctor that Ariel had repeatedly vomited in the few days before she was admitted to the hospital.

If your healthy non-diabetic child repeatedly vomited over several days, would you take them to the hospital or just wait until they collapsed in the hall?

Penny Ratzlaff said...

Red, I wasn't responding to you directly. I'm sorry that you took it as a personal afront. It was not intended to be. I've had several others who were responding to the case and questioned how much the mother was actually taught. I was just responding in general.

Anonymous said...

I know this is an old post, but I wanted to comment on a few things.

First of all, I think it's disgusting that no one in the courtroom challenged the prosecutor's claim that "cheating" on food could have been responsible for this. If her levels were that high from her cheating while away from her mother, who as a responsible parent would have corrected for the overage when she saw it, the obvious effect would have been Ariel gaining weight over time. That's something easily observed by friends, teachers and family members. The side effect of DKA, however, is usually weight LOSS. Also easily observed, and included in testimony by those around the girl. The defense should have done enough research to learn that.

I also found it interesting in the article that this seemed to have begun around the time of Bozet's separation from her husband. Everyone has assumed she was a responsible parent before this happened, and simply stopped, but maybe she was never the responsible parent in the family in the first place.

Then there are the doctors. As someone who is living with type I daily myself, I have encountered some incredibly incompetent physicians and nurses, and these seem to be right in line with that. It amazes me that no one followed up with her after the first episode. As a child of a doctor and someone who has spent countless hours working in his office, I can understand how it is difficult to keep track of patients, and how impossible it is to make them comply, but in life-or-death matters it seems that more involvement was definitely warranted.

Just a few thoughts, and while I'm at it I wanted to let you know I've been inspired by your diligence and smarts as a mom with a diabetic child. It's a hard row to hoe and kudos to you for doing all of the necessary things right!