In high tones he continued the examination of intensivist Andreas Iliadis by her defense attorney Roulas Pispirigouwho focused his questions on both the time Georgina’s objection was met and the “Minchausen syndrome” the doctor investigated for the mother.

As the doctor said “when you have 3 sudden deaths you have to do it”when asked by Mr. Kuya why he investigated the possibility that the mother was ill.

The issue of the syndrome was raised towards the end of the meeting with Mr. Iliadis stressing: “There is Munchausen syndrome by proxy. I am obliged to put it in my differential diagnosis… I put it down. But I had to look into it to rule it out. When you have 3 sudden deaths you have to do it! My answer is this.”

Kugias: Please tell us in which intensive care protocol this should be investigated?

Witness: All pediatricians in the world are obliged to do it!

Chairman: Is this recorded somewhere?

Witness: Of course. It is up to the doctor to inform social services and investigate what is going on. The doctor should contact social services to help both the child and the mother. I turned to the psychiatric clinic of the Hospital. I had a couple of sessions alone with psychiatrists. We agreed that there should be at least one communication from the mother.

Earlier, in a tense atmosphere, the doctor received a barrage of questions about the management of the protest that took place in Karamandanio, but also about the procedure followed when Georgina was rushed to the ICU in Rio.

Receiving many questions about Georgina’s quadriplegia after the arrest, Mr. Iliadis said that the most important thing in the case is the time someone is left without oxygen. As he mentioned, the first minutes are the most critical to provide first aid and he underlined: “When the sudden event occurs, we must have immediate intervention. The famous kiss of life that gives oxygen, is enough to make a rescue. The most important thing is to start chest compressions immediately. Inside the hospital there is an immediate possibility” said the witness who insisted that within the critical first four minutes is the reaction of the mother and the information of the doctors in Karamandanio.

Kugias: We have a paralyzed child who entered the Hospital healthy a week ago. Has the child ever become a quadriplegic?

Witness: Georgina’s objection part is complicated. The main thing is the time the child was without oxygen.

Kugias: So the first few minutes?

Witness: Exactly, very correct. I persist and say that if I’m stuck and help doesn’t come in 4 minutes, then I’m going to have breakdowns. The most important thing from the time of resistance is when someone will call for help! There are 4 minutes!

Kugias: Do you have evidence that the child’s mother did not immediately call for help?

Witness: Do not know.

Kugias: At what stage are the lesions? We have no evidence that the mother did not go immediately. We have evidence that the doctors immediately went. Where did the quadriplegic child become?

Witness: The 4 and 10 minutes do not refer to CPR, but to the time to seek help

The witness, answering questions about the prolonged duration of CPR, which lasted more than 50 minutes, said that he has a successful case of resuscitation lasting 60 minutes. “Unfortunately, there is no data to know in advance what the outcome will be. We have to do it. And 40 minutes and 50 minutes.” At another point, Mr. Iliadis emphasized: “The medical part of Georgina’s opposition is quite complicated. What I think was a catalyst was the time Georgina was without oxygen.”

In a strong tone, Mr. Kougias asked many questions about if and when the parents were informed that Georgina was now a quadriplegic when she was transferred to the ICU of the University Hospital of Patras. The doctor replied that after Georgina was stabilized intubated, they found out the problems, saying that during admission to the ICU “my concern for every child, like Georgina’s, was after her rescue, for a good recovery”.

Kugias: When you heard the revival time did you think if there are other consequences for the little one?

Witness: My agony was until his extubation, which happened after 10 days.

Kugias: Didn’t you care if the child was a quadriplegic or not? When the child was received by Kotsonis (ICU), could you determine if he was already a quadriplegic?

Witness: Absolutely, no. When this “tsunami” ended, we found problems with Georgina’s health.

Kugias: Did you inform the parents?

Witness: For many subjects.

Kugias: Did you inform them that the child is now a quadriplegic?

Witness: As soon as the MRI was done, I informed that we have a bad result in the MRI…

Kugias: But you don’t say a word about quadriplegia. You never told your parents that! And you never mentioned it in your deposition. How do you explain this?

Witness: The condition of a child with ischemic encephalopathy can last for years. To say “quadriplegic” is a term that, well, wasn’t used then. Ischemic encephalopathy is the correct term. I don’t want to use that term, I don’t like it. I was trying to explain what Georgina was gaining, whether she would remain a quadriplegic…

The witness was also asked to answer about the protocol that was implemented when Georgina entered the ICU. As he said “what we immediately thought to do is to place Georgina in a program called therapeutic hypothermia. It’s good to do it even in the ambulance during transport.”

Kugias: So “we froze the little girl’s brain so she doesn’t get brain damage”, that’s what you say.

Witness: These are international protocols that have been proven in all intensive care units around the world. I don’t know the primary damage. I learn them after extubation. I try to catch the secondary ones.

Kugias: At what time can cerebral edema occur?

Witness: The concern of the intensivist, Mr. Advocate, is that after the arrest, if he does not recover, you must put him on the therapeutic hypothermia protocol.

The trial will continue tomorrow