“There are basically three issues to this case: Did Tia Phillips die as a result of some criminal agency? That’s number one. Two: Was Priscilla Phillips responsible? Three: motive. We will present evidence—and to be frank there isn’t a complete explanation—of what appear to be the psychodynamics behind Mrs. Phillips as she engaged in this type of conduct. There will be testimony from staff members at Kaiser about the great admiration they had for her ability to bear up under the strain of the constant hospitalizations. And about the continual and dramatic need to bring Tia into the Emergency Room at odd hours of the night, riding with her in an ambulance; and the great publicity about Tia’s treatment.
“And we will rule out other explanations of these children’s illnesses. Dr. Holliday will discuss that and Dr. Boyd Stephens—coroner of the city and county of San Francisco—will corroborate it.
“We will show evidence that during the course of treatment, Priscilla Phillips became intimately involved with Tia’s treatment and management. She was very familiar with the significance of sodium levels. We will also demonstrate the presence of the defendant on various occasions at the hospital and her presence at or about the time of these dramatic episodes of diarrhea.
“It will be indicated that just like Kaiser, Stanford has procedures regarding the participation of the parents in the care and treatment of their children. Tia had a substantial episode at Stanford, ladies and gentlemen, and this is significant because you could always say maybe there was some deranged nurse at Kaiser-San Rafael who didn’t like Orientals. Was there one at Kaiser-San Francisco? Was there one at Stanford University?”
Josh strode back to his table, and then turned to face the jury once again. Slowly and carefully he began describing the details of Tia’s illnesses and hospitalizations. The exposition continued for over an hour. At each stage he indicated which witnesses he was going to call and to what they would attest.
Following the afternoon recess, the district attorney continued tracing Tia’s course of illness. He explained that an autopsy found no trace of a tumor. He mentioned that approximately one week after Tia’s death, the Phillipses applied to the proper authorities to adopt another child. He detailed Mindy’s illness and treatment and the discovery—by Dr. Estol Carte—of the contaminated formula, and how Mindy’s diarrhea stopped in the ICU.
Finally, he returned to the question of motive. “The People are not required to prove motive, ladies and gentlemen. But Dr. Blinder will testify about reviewing all the medical records in the case, and he will explain to you the symptoms of an individual suffering from Munchausen Syndrome by Proxy. And you can reach your own conclusions about whether those symptoms fit this particular case. Thank you, ladies and gentlemen.”
The judge adjourned the court and an exhausted Josh Thomas turned to Ted Lindquist.
“How did I do?”
“Fantastic,” Ted said.
On Thursday, it was Ed Caldwell’s turn. He had spent hours outlining the central arguments of his case. In contrast to Josh Thomas’s lengthy, dry, and methodical presentation, Ed’s opening argument was short, disjointed, and tinged with the personal. He wanted first to put the trial on a more informal basis. If he was going to win the case, it would be because he was able to make the jury like Priscilla Phillips.
“Sometimes in a jury trial,” he began, “you forget the names of the parties. We are the attorneys: myself—Ed Caldwell—Al Collins, and of course Priscilla and her husband Steve.” He gestured at the Phillipses, who nodded and smiled.
“Now, medicine is as much an art as it is a science,” he continued. “And in this case there are clinical observable signs of unknown origin, such as diarrhea, vomiting, bleeding. And I can give you an example that ties right in with the adoption of Tia and Mindy Phillips.
“Priscilla had two children, Erik, now nine, and Jason, six. And after Jason’s birth, she developed severe uterine bleeding whose remedy was a hysterectomy. Now the cause of that bleeding was never known.
“Similarly, when they did an autopsy on Tia, they didn’t find anything. And in the case of a boy described by Dr. Sinatra to Dr. Sara Shimoda—Tia’s pediatrician—this boy died and had an autopsy performed and in both his case and Tia’s, secretory diarrhea was the cause of death, etiology unknown.” He paused for emphasis, then moved to another point.
“All kinds of tests and procedures were done on Tia, and Mrs. Phillips was constantly urging the doctors to do them as painlessly as possible. It was as painful for Priscilla Phillips as it was for Tia Phillips for each and every one of those procedures, and there will be a lot more evidence to that effect.
“And the evidence will show that an autopsy was performed with the consent of Priscilla Phillips. Steve and Priscilla gladly and willingly consented.
“The evidence will also show that over the entire medical history of Tia Phillips, not once did any expert, examination, study, or test ever suggest that Tia’s condition was caused by either the intentional or accidental ingestion of a contaminant.
“Priscilla Phillips, by her makeup, her character, and her life experiences, was absolutely incapable of even contemplating such acts as have been charged in this case, much less executing them. She has spent a lot of time giving to others in the community, giving to her family. She was active in many organizations dedicated to helping others. She was a giver of life, not a taker.
“Now the evidence will show that Tia—who had been found abandoned in Seoul—arrived in this country in November of 1975, when she was approximately six months old. And there is one medical report that came from Korea showing that she had diarrhea for one month—we don’t know when, but it was sometime before she was adopted by Steve and Priscilla. And then she proceeded to have various ear and urinary tract infections.
“The evidence will show that at one time Kaiser-San Francisco released Tia with a central venous catheter leading to her heart, which Priscilla had to inject with heparin daily. Now if ever there was a time that a mother was going to inflict any harm, that would be the time.
“Now, throughout the illnesses of Tia and Mindy, the evidence will show that the mother was very supportive. That support was encouraged by Kaiser, and this support was commendable. It’s now taken as very suspicious that she was so supportive and so over attentive, though it’s a natural mother’s instinct in caring for a sick child.
“The evidence will further show that in the days before Tia’s final illness, she had been very healthy, and that other members of the Phillips family had been ill with various complaints. And the evidence will show that although they wanted a healthy baby, Mindy Phillips was suffering from cytomegalovirus, CMV, which can produce mental retardation, and, as it did in Mindy’s case, motor coordination disability.
“Now, on the matter of the contaminated formula bottle. Point one: there will be evidence that Mindy’s name was not on that bottle. More importantly: the last time that Priscilla Phillips made the formula was on February twentieth, and this bottle was found on February twenty-fifth.
“Subsequently, the San Rafael Police Department obtained a search warrant and, without notice, went to the Phillipses’ house, and obviously the purpose was to find remnants of baking soda in a bag that she carried to and from the hospital. They took all her handbags and they sent all this material back to the FBI lab in Washington. And no traces of sodium bicarbonate or baking soda were found.” Ed paused to let this sink in.
“I think that the evidence will totally fail to prove any wrongdoing on the part of Mrs. Phillips. Thank you for your attention.” With a slight nod, Ed Caldwell sat down.
While he waited for Josh to call his first witness, he glanced back at Priscilla and Steve. They were seated in back of the defense table, in a row of seats separated from the audience.
They wanted to sit together, and Ed thought the picture of them as a strong and loving couple would present a dramatic image for the jury. Predictably, the prosecutor had argued against the arrangement, but the judge had allowed it. The decision meant that Ed could not see Priscilla, however, and later Ed believed that this was a serious mistake.
ii
Josh Thomas called Sara Shimoda as his first witness. During the months following the preliminary hearing, Josh had met frequently with Dr. Shimoda and with many of the Kaiser doctors regarding the care of the two Phillips children. All of them, and in particular Sara and Evelyn Callas, had been invaluable in preparing, correlating, and charting the hospital records.
Sara Shimoda took the stand shakily. She had been dreading the culmination of an ordeal that had dragged on for a year. It had been supremely difficult for Sara to accept Priscilla’s guilt; Priscilla’s adamant, tearful denials weighed on Sara, reinforcing her doubt. Finally she had come on some level to believe that Priscilla was guilty, that she was mentally ill. The medical evidence was overwhelming and Sara had always been trained to believe in scientific proof. In the end she had to choose between that and what she wanted to believe emotionally. In a last gesture that proclaimed her choice, Sara had handed over to the police the ten-page personal letter Priscilla had written to her after Mindy’s removal.
A great deal of her first day’s testimony was taken up with a long battle between the attorneys over the admissibility of various Kaiser records and a chart prepared by the prosecution. During the discussion, Josh Thomas asked permission to distribute reductions of his chart to each juror, and this was agreed to. The chart, which was to become a focal point of the trial, contained the histories of Tia and Mindy Phillips on a daily basis. There were columns for the patient’s weight, laboratory results, type of intake, presence of mother or father, stool, and emesis. In cases where laboratory results had been abnormal, these were outlined and a color-coded dot placed on the line to indicate the source of the sample. Blood was represented by a red dot, urine by yellow, stool by green.
Using the chart, her notes, and her recollections, Sara recounted the history and course of Tia Phillips’s illness. She described Tia’s early bouts with ear and urinary tract infections, the child’s hospitalization for possible seizure activity, and the onslaught of her diarrhea.
Finally, just after four o’clock, testimony was halted and the judge, with his standard admonition regarding discussion of the case, excused the jury.
Ed Caldwell was satisfied with the day’s proceedings. Al Collins—who was handling the medical witnesses—had pointed out to the jury several mistakes on the People’s chart—one a misplacement of a lab result, others misrepresenting Priscilla’s presence during a particular shift. Dr. Shimoda had found two errors of her own that she presented to the court. None of the errors was serious, but any errors at all tended to discredit the accuracy of the chart.
Sara Shimoda spent all day on the stand Friday as well. Josh next led Sara into a more thorough discussion of Tia’s treatment. He also felt it was important to show how much Sara had admired Priscilla and the ways in which Priscilla’s ego might have been stroked during Tia’s repeated hospitalizations.
“Did you begin to feel any admiration or friendship toward Mrs. Phillips because of her apparent dedication to Tia?” he asked.
“I think I identified somewhat with this mother, who was close to my age and who had an infant who was also close to my child’s age. I understood the strain of not having your child at home to watch her grow and develop. Well, certainly I felt great sympathy for the situation she found herself in.”
“Did you at any time express that sympathy to Mrs. Phillips?”
“I don’t know if I did in so many words. I tried to be supportive.”
“Did you admire her dedication to Tia?”
“Yes, I did.”
“Did you in any way indicate that admiration?”
“I—I think I did in perhaps an indirect way. I don’t think I came right out and said, ‘I really admire you.’ But I felt she certainly was doing the best she could.”
“Did you ever observe Tia in any pain, Dr. Shimoda?”
“Yes. There were times—I—I was impressed by the amount of discomfort this child was in. There were multiple times we had to order sedation, or, if that didn’t work, Demerol.”
“During the course of treatment, did Tia ever give any indications of being hungry or—”
“Well, it was difficult when we had to make her NPO because, in effect, we had to take away what was pleasurable to her, which was to eat. I remember distinctly seeing her sucking on the pacifier like she was saying, ‘Don’t you dare take this away from me!’ She just kept holding onto that because that was the only thing, many times, that she was allowed to have.” Sara paused and looked down at her hands. In her seat behind Ed Caldwell, Priscilla put her head down and wiped away tears.
After a moment, Josh went back to the final months of Tia’s treatment—the laparotomy, the worsening episodes of diarrhea, the high electrolyte readings present not only in Tia’s blood, but in her urine and stool as well.
Sara described Tia’s devastating fluid losses during one of her last episodes in December 1976.
“She lost a tremendous amount of fluid. On the third shift of December third, she lost eighteen hundred thirty-two ccs and this was followed by the loss of fourteen hundred ninety-four ccs the next shift. This is a total of over three thousand ccs lost in a sixteen-hour period of time. It corresponds to a loss of forty percent of this patient’s body weight. And if fifteen percent is considered life-threatening, she had exceeded that many times.”
“Now, Dr. Shimoda, is there anything about the nature of your profession that had any effect on your lack of suspicion of the possibility of intentional poisoning of Tia?” Josh continued.
“In pediatrics we have become aware of child abuse, but it is generally physical abuse. I was not aware of instances of a parent intentionally poisoning a child. I was looking for a disease.”
“Did the relationship or rapport you had built up with Mrs. Phillips and your knowledge of her general background have anything to do with your failure to suspect sodium poisoning?”