Williamson v. State

• Decision Date: 06 May 2010
• Docket Number: 01–08–00366–CR.,Nos. 01–08–00365–CR,s. 01–08–00365–CR
• Citation: 356 S.W.3d 1
• Parties: Laurie Lea WILLIAMSON, Appellant, v. The STATE of Texas, Appellee.
• Court: Texas Court of Appeals

356 S.W.3d 1

Laurie Lea WILLIAMSON, Appellant,

v.The STATE of Texas, Appellee.

Nos. 01–08–00365–CR

01–08–00366–CR.

Court of Appeals of Texas, Houston (1st Dist.).

May 6, 2010.Discretionary Review Refused

Sept. 29, 2010.

Roland Brice Moore III, Houston, TX, for Appellant.

Kenneth Magidson, Harris County District Attorney, Carol M. Cameron, Assistant District Attorney, Houston, TX, for Appellee.

Panel consists of Chief Justice RADACK and Justices ALCALA and HIGLEY.

OPINION

LAURA CARTER HIGLEY, Justice.

These two appeals involve allegations that the complainant, C.W., was the victim of medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy, perpetrated by his mother, appellant, Laurie Lea Williamson. The bases for the criminal charges against appellant are two surgical procedures performed on C.W. in 2001, when he was five and six years old. The State offered evidence at trial to show that the surgeries were not medically necessary and that appellant knowingly and intentionally caused the unnecessary procedures to be performed by fabricating, exaggerating, and inducing the symptoms leading to the surgeries.

Following a joint trial on two separate indictments, a jury found appellant guilty of two first-degree felony offenses of injury to a child, as alleged in each indictment. See Tex. Penal Code Ann. § 22.04(a)(1), (c)(1), (e) (Vernon Supp. 2009).¹ Because each indictment alleged that appellant had caused C.W. serious bodily injury by “cutting him with a deadly weapon, namely, a scalpel,” the trial court included in each judgment an affirmative deadly-weapon finding. The jury assessed punishment at 15 years' imprisonment for each offense, with the sentences to run concurrently. Appealing each judgment of conviction, appellant raises seven identical issues in each appeal.

We affirm the judgment in each appellate cause.

Background

Appellant and her husband had two sons: the complainant, C.W., born on March 16, 1995, and D.W., born on May 21, 1997. They also had one daughter, L.W., born on September 1, 1999. After L.W. was born, appellant divorced the children's father and became the children's primary care giver.

By the time he was five years old, C.W. already had been diagnosed with a number of medical problems, including Crohn's disease, which is an intestinal disorder, Tourette's Syndrome, attention deficit hyperactivity disorder, and obsessive compulsive disorder. C.W. took a number of medications for these afflictions.

Appellant also reported to C.W.'s doctors that C.W. suffered from “staring spells,” in which C.W. would stare, “zone out,” and be non-responsive. After these spells, appellant claimed that C.W. would often fall asleep and lose bladder control. These episodes reported by appellant were diagnosed as “partial complex seizures,” a form of epilepsy.

For his seizures, C.W. was referred to Dr. Balbir Singh, a neurologist, who specializes in pediatric epilepsy. During C.W.'s first visit, Dr. Singh noticed that C.W. appeared to be “doped up” or over-medicated. C.W. was drowsy and unsteady on his feet. Dr. Singh ordered a blood test, which revealed that C.W. had levels of Dilantin, an anti-seizure medication, at twice the recommended level.

Dr. Singh tried to control C.W.'s seizures with medications. Appellant continued to report to the doctor that C.W. experienced seizures. Several medical tests were performed on C.W., including electroencephalography (EEG) tests. An EEG is an electrical test of the brain, which can aid in determining whether a person has seizure activity.

The EEG tests performed on C.W. were not definitive. At least one of the tests indicated abnormal “generalized epileptic form activity,” which showed a correlation with seizure activity. Other EEG tests performed on C.W. indicated no abnormal activity. Dr. Singh had a video EEG performed on C.W. over a 23–hour period. During that period, appellant reported that C.W. had three or four seizures, but none were recorded on the EEG.

Despite the fact that Dr. Singh had C.W. on the maximum dosages for anti-seizure medications, appellant reported that C.W. continued to have up to 11 seizures a day. Based primarily on appellant's report of the continued seizure activity, Dr. Singh referred C.W. to a surgeon for the implantation of a vagal nerve stimulator, a device that can decrease seizure activity when medications have failed. At trial, Dr. Singh testified that the vagal nerve is the nerve that runs from the brain to the stomach. With regard to the procedure, the doctor explained that the vagal nerve stimulator is a device that “can be inserted just under the skin ... and then a wire goes from the device to the nerve” and “then winds around the nerve.” He continued, “[T]he device stimulates the nerve every one minute or every 10 minutes. We can program the device from the outside.” Dr. Singh further explained that “we can change the settings of the [vagal nerve stimulator] device to give the shocks at different times and different strengths.”

A surgeon, Dr. James Baumgartner, implanted the vagal nerve stimulator on January 5, 2001. Dr. Singh set the vagal nerve stimulator at different strengths but the device did not stop the seizures, according to appellant. The device was deactivated six weeks after it was implanted and was never reactivated. Appellant continued to report that C.W. suffered from seizures.

C.W. was hospitalized in February 2001 with a “failure to thrive” diagnosis, which meant that C.W. was not growing properly. A pediatric surgeon, Dr. Paul Minifee, surgically placed a central line into C.W.'s subclavian vein to provide C.W. nutrition. While he was hospitalized, C.W. was seen by many specialists from several disciplines, including neurology, endocrinology, hematology, oncology, and genetics. A concern was raised by the neurology team that perhaps C.W. was a victim of Munchausen Syndrome by Proxy by appellant. The doctors had a child protection meeting, and it was decided that they did not have enough evidence to make a Munchausen Syndrome by Proxy diagnosis.

Prior to C.W.'s discharge from the hospital, Dr. Minifee placed a nasal gastric feeding tube through C.W.'s nose, down his throat, and into his stomach. The purpose of the tube was for C.W. to be fed liquid formula.

Around this time period, others also had concerns for C.W.'s welfare. When C.W. was in preschool, he was a happy, spunky, smart preschooler. C.W. continued to kindergarten at the same school, and C.W.'s teachers began to notice a change in him.

Appellant told the school that C.W. was on a special, restricted diet. The teachers noticed that C.W. was very thin and losing weight. At trial, C.W.'s teacher said that he was “just skin and bones.” C.W. always seemed hungry and craved food. However, the teachers could not give C.W. food because of his dietary restrictions.

The teachers also noticed C.W. appeared very tired. C.W. would, at times, have to lay down in the nurse's office. C.W.'s teachers were concerned that he was being over-medicated. C.W. also appeared to be regressing intellectually.

In November 2000, one of C.W.'s teachers, the school psychologist, and the school nurse drafted a letter that they planned to send to C.W.'s doctors. The letter detailed their concerns regarding C.W. and requested the doctors' assistance. The teachers were concerned that appellant was abusing C.W. In the letter, they stated their observations and expressed concerns regarding C.W.'s weight and his medication. When confronted with the concerns, appellant withdrew C.W. from public school to home school him. The letter to C.W.'s doctors was never sent.

Appellant's neighbors, who babysat C.W., also had concerns. Appellant told the neighbors that C.W. was on a restricted diet. Appellant provided the food for C.W. to eat while staying at the neighbor's house, which was bland and unpalatable. The neighbors were concerned because C.W. was emaciated and lethargic. He would beg for food from the time appellant dropped him off until the time she picked him up.

In November 2001, appellant took C.W. to see Dr. Minifee. The purpose of the visit was for the doctor to evaluate whether C.W.'s nasogastric feeding tube should be replaced by a gastrostomy feeding tube. Appellant told Dr. Minifee that C.W. had a “feeding disorder” and hypotonia, which is decreased muscle tone. Appellant reported that C.W. could not hold himself up or walk comfortably.

Appellant also expressed concern to Dr. Minifee that C.W. had mitochondrial disease, which is a genetic disorder. On December 11, 2001, Dr. Minifee surgically placed a gastrostomy tube through C.W.'s abdomen into his stomach.

While C.W. was under general anesthesia, Dr. Minifee also took a sample of muscle tissue from C.W.'s leg to be tested for mitochondrial disorder. Testing on the muscle sample revealed a negative finding for mitochondrial disorder. Despite the negative finding, appellant continued to represent to others that C.W. had mitochondrial disorder.

C.W. eventually began using a wheelchair. Although he had been potty trained at the age of two, C.W. became incontinent of bowel and bladder.

On January 10, 2006, C.W.'s pediatrician wrote a letter, at appellant's request, “to whom it may concern.” The pediatrician was also the primary physician for C.W.'s siblings. The January 10, 2006 letter detailed each child's medical history. With regard to C.W., the doctor wrote the following:

[C.W.] is an almost eleven-year-old patient with multiple medical problems including mitochondrial disorder, metabolic disorder, neurological regression syndrome, global development delay, seizure disorder, hypotonia, status post history of failure to thrive, gastrointestinal malabsorption, gastroesophageal reflux, esophagitis, status post gastric-button placement, hypothyroidism, hypotension, urinary incontinence, stool incontinence, heat intolerance due to poor thermoregulation from the metabolic disease state,...