With bated breath, judges, jurors and the audience watch the testimony of the head of the Children’s ICU at the University Hospital of Patras, Andreas Iliadis at the trial for Georgina’s death.

The intensivist gave detailed history of medical procedures that happened to the child and the communication he had with the parents. He referred to his relationship with the mother and how “the suspicion entered his mind that she was causing harm to the children”.

In today’s trial, Manos Daskalakis, who was absent due to work in the last sessions, while the mother and sister of the accused also came. However, the president asked them to leave the room while Mr. Iliadis was testifying.
Mr. Iliadis, head of the pediatric intensive care unit of the hospital in Rio, began testifying about the medical data in the trial of Roula Pispirigou for the death of little Georgina.

” On 11/4 when Georgina was admitted I had no service. I received a call from the doctor on call, he told me exactly that there is a call from Karamandanio for a very serious incident, cardiac arrest. I told him I was going to the hospital. When I arrived the transfer had not yet taken place. The colleagues were preparing the child’s bed. Georgina arrived intubated with Mr. Hasapopoulos accompanying her. It was very intense. The child was placed in the Intensive Care Unit after Mr. Hasapopoulos informed us what happened to the child. We immediately put her on a ventilator, stabilized her, checked her vitals and hooked her up to the monitor. We understand that this is a very serious incident.

They let us know it was something sudden and that the child was being treated without any indication of such a thing.

In the first hours of dealing with the incident we found out a perfectly normal cardiogram. This made us calmer because children with seizures have an “outburst” of symptoms that we have to deal with.

As the minutes ticked by and hours we had a fairly stable image of the child. Because the child showed this stable picture we decided to follow the protocol of therapeutic hypothermia, a complex procedure which often shows arrhythmias. This therapeutic method helps to save the brain and prevent swelling.

I want to emphasize that in-hospital cardiac arrests they have a much better prognosis and that gave us hope. When an arrest occurs in a hospital it helps us to know the times the brain was deprived of oxygen.

Pediatric patients are not miniatures of adults. We know that a child’s heart cannot have a heart attack for example.

Cardiac arrest in children is 80% due to respiratory causes. It is caused due to respiratory failure. Anything to do with the oxygenation disorder of the body.

Georgina just arrived I had an ultrasound and I found that this heart was able to perform the function it wanted.

I have not seen a heart attack in my career and I have been through all the intensive care units in Greece. Only Cavasaki disease can cause a heart attack in children. Without being 100% sure we had ruled out as many causes as possible and ended up with this treatment of therapeutic hypothermia.

I urgently asked the parents about how the objection was made. And how much time has passed. I asked the mother. If the time exceeds 10 minutes from the time CPR started, then the most serious brain damage begins.

It was a dramatic night. I left at 5 in the morning. We had all fallen for Georgina. Unfortunately we didn’t have a diuresis. Usually when we have a cardiac arrest it is not certain that the kidneys will function normally afterwards. We were ready to start dialysis.

We managed to get a diuresis after some hours, luckily, luckily Georgina did us this favor and thus we avoided dialysis.

I immediately informed the parents, they were two sad parents… I told them they have nothing to fear because the child is in good hands.

When someone presses on the chest for 50 minutes, that alone is enough to raise troponin. It was certainly something that concerned us but at that moment we knew there was intensive CPR. Besides, the most important thing is how the value of troponin develops over time. Eventually the troponin dropped in an incredibly short period of time.

If there was a serious heart problem we would wait 2 weeks for it to drop.

I realized that this heart had suffered dyspraxia in an oxygen-deprived environment.

I had an obligation to look for detail about the child’s history. I was informed that there was Malena’s sudden death attributed to liver failure.

I called Mrs. Baca, a well-known pediatric oncologist at Paedon. I spoke with her twice and she told me that she was not convinced that Malena died of liver failure. I asked for more information and as a doctor it was inconceivable to me to believe it. Because I know what liver failure means, children don’t suddenly die of liver failure.

There was also the information about the second child, about the second death. My mother said that and at first my mind went to sudden death syndrome while she was sleeping.

We had a couple of deaths to deal with. I immediately got Mr. Papagianni who is the best doctor we have in Greece, specialized in arrhythmias.

We had focused on the heart and that’s how the famous gene test started.

We turned to Mr. Anastasakis who begged him not to take money because the family had nothing to give. Genetic testing is a very expensive process. I told him I would do whatever it takes, maybe we would ask for money from some agency, or do something to find money. He told me “no need…” And so began gene testing by a doctor who is the cream of the crop of the country.

It is worth noting that the mother left the room when the witness mentioned Munchausen syndrome

The bell that rang for me was the 3 sudden deaths. Something else has now been added to my diagnosis. Munchausen syndrome by proxy.

How did it come to me? If he gets the idea that the child’s caregiver, who is the mother, who has medical knowledge, likes to show off her knowledge in that field. They are usually people with mental problems, but that doesn’t concern me. My goal was to protect the child, because this is abuse. With symptoms of suffocation.

There were “red flags” that shook me. So I decided to talk to some institutional body which was the forensic service. I addressed the responsible medical examiner of the Ministry of Justice, Ms. Tsiola. He listened to me very carefully and came to the intensive care unit.

There is a huge gray area between medical and legal examination of this matter. My hands were tied, but as Georgina’s doctor I had to look into it.

I expressed my suspicions to Mrs. Tsiola and asked her what she advises me, as an institutional person. He told me to wait for the genetic test to be done and if the data is different to look at it again. In fact, he told me to be close to the family.

I knew all too well the difficulties of this gray zone in which I navigated.

Then I sought the help of the psychiatric University clinic. I spoke to the assistant manager and told him the whole story. I felt like I dropped a bomb and he referred me to the manager. I told everything, my concerns, but I felt that there was no way to help. All I managed was to get an appointment from the psychiatrist on duty and they even told me not to inform him ahead of time.

So I sent the mother to make this appointment. I don’t know how psychiatry handled it but the result was probably not good. The parents came and my father said that the psychiatrist was asking her “if she is crazy”. Unfortunately this led to a break in communication with psychiatry.

Georgina’s parents told me that they do not want this kind of intervention.

I want to mention something. During Mrs. Tsiola’s visit to the intensive care unit we had a discussion. Georgina’s mother was listening behind the door. When the door opened, he said “Mr. Iliadis, I heard everything”. I told her that it is none of her business what I say with my partners.

Although I expected them to come in like raging bulls, they didn’t come like that. They came in a very friendly mood and asked me not to engage in such things.

This situation suggests to the doctors who will deal with it not to go directly to the Prosecutor’s Office, the suggestion is to turn to social agencies.

So I thought of the Child’s Smile. I called, talked to them, a contact was made with the family. My second phone though was much clearer about what might be going on. They said they can’t help me. So I left it there and went back to the kid.

After the extubation, the little one managed to maintain her airways and we decided to enter a rehabilitation program, while we had to see what we would do with her little heart.

The monitors in the unit had picked up nothing, nothing!”