A specialist children’s nurse is adamant that red marks she saw on a child were the result of pinching inflicted by the mother, whose hands she discovered under the hospital blankets.

“I know what I saw - two hands placed on a child tight enough to leave red marks behind,” paediatric intensive care nurse Jodie Purches has told the High Court.

Her comments came during an unflinching cross-examination in the trial of a woman accused of mistreating her child during medical care.

The expected six-week trial in the High Court at Nelson has now entered its fourth week.

Crown prosecutor Mark O'Donoghue (left) and senior barrister and member of the defence team, John Wayne Howell. The trial involving a mother accused of medically abusing her child continues in the High Court at Nelson. Photos/Tracy Neal.

The mother, whose name is suppressed to protect the child’s identity, has pleaded not guilty to four charges of ill-treating a child and three charges of infecting with disease.

The mistreatment was alleged to have occurred over a 19-month period. The allegations arose from medical interventions required for the child’s assisted feeding and treatment for complex intestinal failure.

The defence argues the events which formed the charges arose from management of a “medically fragile child living with complicated medical devices” and the actions of a desperate mother trying to help her child, who originally presented with suspected reflux disorder, and failure to thrive.

Purches’ cross-examination followed what Justice Lisa Preston described as a “marathon of evidence”.

She was one of a long list of witnesses in the Crown case, most of whom have been associated with Child X during treatment and care in hospitals around the country.

‘Gripping’ child’s limbs

Purches claimed she saw the mother gripping her young child’s limbs under a blanket, leaving red marks.

She alleged that as soon as she removed the blanket, the mother removed her hands.

On another occasion, she says she saw the mother holding a central line (a tube used for feeding and administration of medicine) connected to the child with what she described as an “intentional grip”.

When challenged by the defence over the possible cause of the red marks, Purches said she believed they were caused by the mother pinching the child.

She said a full assessment was then carried out and senior staff were informed, while the child was given medication for distress, and soon settled.

Lack of documentation challenged

However, she was challenged by the defence over why she had not specifically documented the incident, which the mother claimed was caused by a condition called “red man syndrome”.

The condition was described online as a reaction to rapid intravenous infusion of a specific drug, which caused histamine release leading to itching and a red rash on the face and torso.

Purches said she had extensive knowledge of the condition, having seen it multiple times in children and adults, and what she saw on the child was “absolutely not consistent” with red man syndrome.

Assistant Crown prosecutor, Abigail Goodison, asked Purches what medical records or clinical notes she would have looked at to check, and was told any known allergy would have been documented at the top of the observation chart.

At the time Purches alleged the harm was intentional, she said the mother had also called for help.

She told defence lawyer John Wayne Howell in cross-examination the mother reported the child was “gagging”.

When questioned further, she said distress could cause this to occur.

Purches said she was about a metre from the child’s bed, and the blanket was on, from “chin to toe”, and as soon as she removed it, the mother removed her hands.

Crown prosecutor Abigail Goodison in the High Court at Nelson. Goodison was assisting the prosection in a trial in which a mother was alleged to have medically abused her child. Photo / Tracy Neal.

She also alleged the mother had, at one stage, an “intentional grip” on the lumen, which was part of the child’s central line.

Purches alleged the mother had her forefingers and thumbs around the lumen, gripping it in a manner causing it to “kink”, which would stop medication going through.

Touching it also raised the risk of infection, she said.

When asked if paediatric intensive care nurses were trained to be vigilant over lumens, Purches said they were, but something like a kink would not necessarily be documented in records, but adjusted accordingly.

She said she spoke about it directly with the mother and raised it with the nurse in charge at the time.

‘Did what was best at the time’

When challenged further by Howell over why she had not specifically documented what happened, Purches said because the line had not broken there was no need to.

Howell raised that her allegation about the lumen was made in a written statement a year later, and during the time the child’s care was by then under investigation.

Purches agreed, and that while certain events had not been documented, she had based her evidence on what she saw and recalled from the time.

She was also challenged on her knowledge of child protection procedure and policy of the hospital where she worked, and of the wider health district, and whether that meant she had an obligation to report what she saw.

Purches said she did what she knew was best at the time, which was to “remove the danger, check the child was okay and escalate [the matter] to the charge nurse”.

Goodison pointed out, after a broader look at the full policy, it stated decisions on reporting were not to be made by one person alone but were to be reported to a manager.

Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.