A horrific case of ‘medical child abuse’
On February 28, 2006, two women who hardly knew each other, Darcy Wall and Susan Owen, walked into the Harris County Constable, Precinct Four substation together. Darcy is a mother of two children and the wife of a pastor at a local Bible church. Susan is a nurse in a pediatrician’s office. They had both been close friends and supporters of Laurie Williamson, the mother of three terminally ill children. They had little else in common other than a growing fear that the children were in danger and the courage to do something about it. They had come to report their friend Laurie for child abuse.
Sgt. Mike Johnson of the Domestic Violence Unit listened to the two women patiently. He could see that their concern was genuine and seemed legitimate, but he was initially uncertain of what to do. Darcy and Susan believed that Laurie had Munchausen Syndrome by Proxy (MSBP) and that she was pretending her children were sicker than they really were. It sounded to Johnson like a problem for CPS to handle, but the women had already reported the matter to CPS, to no avail. After researching MSBP on the Internet, Johnson determined that it was indeed a form of child abuse that could result in permanent injury or even death. His search turned up a news article about a local case of MSBP that had recently been prosecuted; Kimberly Sue Austin was the defendant. Johnson decided to contact the prosecutor who handled the case, and that’s where I came in.
I had tried Austin less than six months earlier for injury to a child. She had injected her infant son with insulin, almost killing him. Further investigation had determined that she had murdered another infant son in 1993 by either suffocating him or injecting him with insulin. At trial I had shown that the two children, as well as two other Austin children, were victims of MSBP, also known as “factitious disorder by proxy,” (FDP), “pediatric condition falsification” (PCF), and, most recently “medical child abuse” (MCA).1 All of these acronyms describe the same conduct: the intentional exaggeration, fabrication, or induction of illness symptoms in a child by the child’s caretaker, resulting in unnecessary and harmful or potentially harmful medical care.
‘I hope you’re ready to work’
Realizing the danger posed to the children after discussing the case with Sgt. Johnson, I told him that we needed to take swift action, and I offered to help him with the investigation. But I also had a warning for him: “I hope you’re ready to work.” MCA prosecutions are notoriously difficult and time-consuming.
We began by issuing grand jury subpoenas to every health care entity we knew of that had seen the children. Then Johnson started taking statements and collecting letters from various friends, family members, and other people who had knowledge of what was going on in the Williamson household. The picture that emerged was disturbing.
Laurie Williamson had three children: Tom, age 11, Roger, 9, and Chrissy, 6.2 They wore diapers because none of them were toilet-trained, and Tom and Chrissy were confined to wheelchairs and had “g-buttons” (gastronomy tubes) through which liquid formula could be pumped directly into their stomachs. Laurie told everyone that the children had mitochondrial disease and a regressive neurological disorder, among other ailments, and that they were not expected to live beyond their teens. The Williamson household was dark, with heavy shades on the windows, and Laurie set the temperature at 62 degrees because she said the children were sensitive to heat and light. Consequently she kept them indoors and rarely allowed them outside to play. All three children were on numerous prescription medications meant to control a host of different problems. Chrissy’s medicine had to be administered through her g-button as she was never allowed to eat or drink anything by mouth. Her mother said she had a swallowing disorder and would choke.
One of the first things Sgt. Johnson obtained was a pair of letters from the children’s pediatrician. The first, dated January 10, 2006, and addressed “to whom it may concern,” listed all the problems with which the three children had supposedly been diagnosed. Tom, for instance, had “mitochondrial disorder, metabolic disorder, neurological regression syndrome, global developmental delay, seizure disorder, hypotonia, status post history of failure to thrive, gastrointestinal malabsorption, gastro-esophageal reflux, esophagitis, status post gastric-button placement, hypothyroidism, hypotension, urinary incontinence, stool incontinence, heat intolerance due to poor thermoregulation from the metabolic disease state, attention deficit/hyperactivity disorder, Tourette’s syndrome, decreased acoustic reflexes in the right ear, obsessive-compulsive disorder, anxiety disorder, pragmatic language disorder, decreasing IQ scores, sensory integration disorder, auditory processing disorder, and poor immune function.” Her assessment of Roger and Chrissy was similar.
The second letter, written just a few weeks later on March 1, represented a 180-degree turn. “It has recently come to my attention that there are several extremely serious issues in regards to the health of the children and the possibility of Munchausen’s Syndrome as well as Munchausen’s Syndrome by Proxy with this family.”3 Now even the pediatrician, who had been fooled by Laurie for eight years, could finally see that things were not adding up. The children, still in Laurie’s care, were in grave danger. The situation called for immediate action.
I asked Sgt. Johnson to contact CPS and remove the children from Laurie’s custody. Prosecuting MCA cases requires a multi-disciplinary team approach, with cooperation between law enforcement, health care workers, and CPS. CPS had investigated at least five previous referrals that Williamson was neglecting or abusing her children, but each time, she had been able to convince the caseworker that her children were genuinely ill and that she was doing the best she could to take care of them. If we were ever to prove that Williamson was medically abusing her children, we would have to enforce what pediatricians refer to as “therapeutic separation” to see if the victims got better once they were out of the perpetrator’s care. Therapeutic separation is always the ultimate proof of MCA. If the children’s health problems abruptly resolved themselves away from Laurie, it would be the most powerful piece of evidence I could offer in court.
On March 20, 2006, after an emergency meeting that Sgt. Johnson and I attended with CPS officials and caseworkers, CPS took emergency custody of Tom, Roger, and Chrissy. Shortly thereafter, they were admitted to the hospital for observation. With MSBP as their working diagnosis, the attending physicians weaned the children off of a multitude of prescription drugs their mother had been giving them, ordered the removal of the g-buttons from Tom and Chrissy, and eventually discharged them all in excellent health, having ruled out almost all of the diagnoses their pediatrician had mentioned in her January 10 letter. Chrissy ate solid food for the first time in her life without any problem swallowing. Other than some (understandable) behavioral issues, they were in perfect health.
How to charge Williamson
The question now was: With what offense could we charge Laurie Williamson? “Munchausen syndrome by proxy” and “medical child abuse” are not offenses. After reading the final discharge report from the hospital and the statements taken by Sgt. Johnson, I was confident I could prove that she had endangered her children according to the broad definition of §22.041 of the Penal Code. But the state jail felony punishment range hardly seemed appropriate in this situation. In most cases of MSBP, the perpetrator is caught personally harming the children in some way: smothering them, injecting or poisoning them, tampering with medical equipment, or even deliberately trying to infect them. Sometimes—if doctors are suspicious—the offense may even be covertly recorded on video. These acts usually fit the definition of injury to a child under §22.04.
But in Williamson’s case, we did not even have an affirmative act, much less one caught on video. Clearly, the children had suffered unspeakably at her hands, but how could we hold her responsible? I discussed the case with Dr. Reena Isaac, a pediatrician specializing in child abuse and a member of the Child Protection Team at Texas Children’s Hospital. Dr. Isaac proved to be my right hand, an indispensable help throughout the prosecution. I explained my charging dilemma, and she pointed out that the children had undergone numerous unnecessary tests and even surgeries under their mother’s care and with her consent. As we brainstormed, an idea began to form: Could an unnecessary surgery constitute injury to a child? I went over the legal definitions with Dr. Isaac, including “serious bodily injury.” Her response was swift and certain: Any procedure involving general anesthesia created “a substantial risk of death,” and the surgery itself could cause “serious permanent disfigurement, or protracted loss or impairment of the function of any bodily member or organ.”4
But doctors had actually performed the surgeries, not Laurie Williamson. Were we going to claim their conduct was criminal, as well? I turned to a little-used subsection of the law of parties, Texas Penal Code §7.02(a)(1).
(a) A person is criminally responsible for an offense committed by the conduct of another if:
(1) acting with the kind of culpability required for the offense, he causes or aids an innocent or nonresponsible person to engage in conduct prohibited by the definition of the offense.
My theory of culpability for Laurie would therefore involve proving three things:
• that the surgeries were medically unnecessary;
• that the surgeries met all the elements of injury to a child with serious bodily injury; and
• that Laurie Williamson intentionally and knowingly caused the surgeries.
This case would mark a first in medical child abuse prosecution: attempting to secure a conviction based solely on unnecessary surgical procedures.
Mountains of paperwork
The first step was to subpoena all medical records for all three children and Williamson herself. I included her records because a significant number of MCA perpetrators also exaggerate, fabricate, or induce symptoms in themselves. This would turn out to be true in Williamson’s case as well. For the next several months, I issued grand jury subpoenas and Sgt. Johnson dutifully served them. To minimize duplication and confusion, we agreed that CPS, represented by the Harris County Attorney’s Office, would serve as a central repository for all records we obtained, and that Sgt. Johnson would have his office scan in the records as PDF files and put them on CD-Roms. The process was time-consuming and exhaustive, but eventually we got most of the records we wanted. They totaled over 40,000 pages.
I then began going through the records to create a chronology of medical contacts in the form of a Microsoft Excel spreadsheet. I owe a debt of gratitude to several interns, most notably Amanda Johnston, who assisted in this tedious, eye-straining, mind-numbing task. On the spreadsheet, I entered the date, name of the patient, type of event (phone call, office visit, admission, etc.), provider, and complaint and diagnosis, if any. When I finished, I had documented nearly 600 doctor visits, hospitalizations, phone calls, and other contacts for Williamson and her children. I did not even include the speech, occupational, and physical therapy all three children received at home three times a week.
Next, I catalogued the records for easy reference and had Sgt. Johnson scan almost three dozen statements and letters from various witnesses. To prove my case, I was going to need experts, specifically, pediatricians specializing in the recognition and treatment of child abuse. They would need to review all of the records to form opinions on whether the children were victims of medical child abuse and whether the surgeries in question were necessary. If I was going to ask a jury to send Williamson to prison based on expert testimony, then I needed that testimony to come from some of the foremost pediatricians in the country.
I did not want to rely solely on experts, however. After reviewing the records, I began tracking down the actual doctors who had recommended and performed surgeries on the children. After talking to Dr. Isaac, I was targeting three procedures: a g-button placement/muscle biopsy and a vagal nerve stimulator (VNS) implantation performed on Tom, and a g-button placement/nissen fundoplication performed on Chrissy.
Going into the case, like many people, I believed that there would always be some “test” or other objective basis before a doctor would perform a surgery. When I contacted the treating physicians, I asked them for any objective data that supported the surgeries, independent of information that came from the mother. To them, the question made no sense. Pediatricians rely almost exclusively on the history given by the child’s caretaker. They assume that the caretaker is telling the truth because the caretaker wants the child to get better. Clinical tests, while useful, are seldom as conclusive as we would hope and will almost never by themselves justify a surgery. The history from the caretaker and any objective results or observations are given equal weight and are considered indistinguishable.
In the case of the Williamson children, I discovered that there were almost no test results or objective bases for the surgeries that their mother could not have somehow manipulated. The g-button surgeries, in which Tom and Chrissy had feeding tubes implanted into their stomachs to supply them with formula, had been performed because they were failing to thrive. Although the children had been losing weight and were not growing and developing properly, this problem could have been caused by simple malnutrition rather that some rare metabolic disorder. The vagal nerve stimulator had been implanted in Tom to help control persistent epileptic seizures. But, while a few EEGs had been abnormal and suggestive of seizures, no actual seizure had ever been recorded, despite repeated and lengthy tests. Instead, the surgery had been performed due to Williamson’s reports that Tom was having up to 10 seizures a day despite taking powerful anti-seizure medications. Dr. Isaac and other physicians confirmed that none of the surgeries appeared to have been medically necessary and that Williamson appeared to have been pushing the doctors to perform them.
Even more experts
In April 2007, once satisfied that the evidence met all the elements, I presented the case to a grand jury, which indicted Williamson for two cases of injury to a child with serious bodily injury and three cases of endangering a child. The injury cases represented two of Tom’s surgeries, while the lesser endangering cases covered the broad mistreatment each child had experienced. To give the charges teeth, I alleged the surgical scalpel as a deadly weapon in the injury cases, which seemed appropriate as it was the instrument used to inflict needless suffering on Tom. Sgt. Johnson and I tracked down Williamson, who had moved into a shelter for battered women5 after losing her children, and arrested her—at a doctor’s office, of course.
With the defendant in custody, preparation for trial began in earnest. After obtaining supervisors’ approval to hire experts, I recruited two teams composed of some of the foremost experts on child abuse in the nation. The first team represented Texas Children’s Hospital and Baylor College of Medicine and consisted of Drs. Reena Isaac and Joan Shook. The second team represented Children’s Memorial Hermann Hospital and the University of Texas Medical School and consisted of Drs. Rebecca Girardet, Margaret McNeese, Sheela Lahoti, Kim Cheung, and Christopher Greeley. The teams would operate independently and form their own opinions after reviewing the records. Within the teams, I allowed the physicians to consult with each other, share opinions, and divide the responsibilities however they saw fit.
Each team member received a packet of materials: seven CD-Roms containing all the medical records on Williamson and her children; the completed chronology of events spreadsheet summarizing the contacts; a catalog of the CD-Rom contents; a page of legal definitions; a brief set of instructions, and a list of questions they were to answer. I included on the CD-Roms copies of all the letters and statements Sgt. Johnson had collected and asked my experts to review them and give them whatever weight they wanted in arriving at their opinions. Just like a forensic pathologist trying to determine a cause of death, they would not be confined to looking at the body only; they could consider outside sources of information as well. The goal was to have the experts base their opinions as closely as possible on the same body of evidence with which the jury would be presented.
In an effort to streamline the process, I gave the experts a six-month deadline and made a proposal to the defense that had worked well in the Austin case: I would give them CD-Rom copies of everything: Medical records, witness statements—everything. In return, all I asked was that they stipulate to the authenticity of the records under Texas Rule of Evidence 902. This agreement served two purposes: First, it would save me the trouble of filing the records with the clerk 14 days in advance of trial, and, second, it would satisfy my duty to disclose exculpatory evidence. While the records held no earth-shattering proof of innocence, they contained many facts that could be argued to be exculpatory. Perpetrators of MCA are clever, and often they merely exaggerate symptoms that are really present in the child. The Williamson children had undergone countless tests, the vast majority of which were normal, but some of which were either abnormal or inconclusive. Finally, on some occasions, they really had been sick. The last thing I wanted was to be accused of hiding evidence. The defense would be stipulating only to authenticity; they reserved the right to object to items within the records.
Going to trial
It took more than a year for the case to come to trial, but on April 4, 2008, we began. I was privileged to have sitting with me Kate Dolan, a veteran prosecutor in our office and one of my colleagues in the Major Fraud division. Kate brought fresh insight and experience to the table and was vital to the case’s success. The trial lasted four weeks, and we called over three dozen witnesses. Many were former friends of Laurie who had helped and supported her over the years. These were churchgoing, traditional, stay-at-home mothers, some of whom had special needs children of their own, and all of whom had felt compassion for Williamson. When I contacted them prior to trial, I expected them to be ambivalent, perhaps even tearful about the prosecution, and I tread delicately. When I asked if they were comfortable with the fact that I would be asking the jury to send their friend Laurie to prison, their cool, matter-of-fact responses left an indelible impression upon me. To a woman, every one of these Bible-studying soccer moms firmly and resolutely wanted Williamson locked up—for as long as possible. While their support was a welcome surprise, I was still taken aback at the cold-blooded, dispassionate attitude. Only later would I understand why they showed no mercy for Williamson: They knew firsthand what she had done to the children. And it was awful.
At trial, the evidence proved that for about six years, Laurie Williamson had systematically starved and overmedicated her children in an effort to simulate and induce the symptoms of various illnesses. At the same time, she had failed to teach, train, and nurture her children, while exposing them to countless unnecessary tests and invasive procedures. The result was that Tom, Roger, and Chrissy appeared to be chronically ill and developmentally disabled, unable to perform basic tasks or physically take care of themselves.
The defendant told people that her children were terminally ill, that they had a mitochondrial disorder, and that they were not expected to live beyond their teens. She often said these things in their presence. The motive for the abuse was to gain sympathy, support, and financial contributions from various people and entities, including the government. Williamson, who was unemployed, lived off a combination of child support, disability benefits for her children from the Social Security Administration, and donations from her friends. From 2000 to 2005, she received more than $150,000 from fellow church members (at different churches) and even more than that in donated goods and services. In 2004, with the help of the children’s pediatrician, she had even gotten a free trip to Disneyworld, paid for by the Make-a-Wish Foundation. When the investigation began, she was in the process of trying to raise over $300,000 to purchase a new wheelchair-accessible home and van.
The only problem was that none of it was true. The children were not terminally ill, they did not suffer any kind of mitochondrial disorder, nor did they have any of the absurd list of illnesses she recited during her fundraising efforts. This list of ailments, which she had her pediatrician include in the January 2006 letter quoted above, were possible diagnoses she had “collected” over the years from various physicians and specialists. She represented them as confirmed when in fact, in many instances they had actually been ruled out.
Williamson’s deceptions did not go completely unnoticed. As far back as 2000, teachers and counselors at Tom’s school became concerned that the once bright, playful preschooler became thin, malnourished, and lethargic. They testified that he seemed “zoned-out” and that they were concerned that his mother was overmedicating him, especially after he improved during a stay with his grandparents. During a meeting about Tom, these school officials discussed the possibility of MSBP. They decided to begin weighing Tom on a regular basis and even took the extraordinary step of drafting a letter to two of his physicians expressing their concerns.6
Williamson responded in the same way she always did when suspicions arose: by cutting contact with the suspicious party. She transferred Tom to a different school and ultimately withdrew him entirely, saying she was going to home-school him. She repeated this pattern with anyone who questioned her: her ex-husband, her friends and neighbors, her parents and sister, and her fellow church members. And while few doctors ever doubted her, if they did she moved on quickly, using HIPAA as a shield and refusing to sign information releases. In 2002, for instance, after physicians at Texas Children’s Hospital became suspicious of possible MSBP, Williamson moved on to specialists at Children’s Memorial Hermann Hospital.
Many who had regular contact with the Williamson family, particularly the therapists who saw the children twice a week and measured their progress, noted that Williamson seemed to seek out new equipment and diagnoses for the children and consistently downplayed and minimized their progress. She was adamant that Roger needed a g-button like his siblings, even though he ate normally when allowed to.
For two years, neurologists, geneticists, and other specialists in the UT system puzzled over the Williamson children, baffled by the wide array of symptoms their mother described. In August 2004, Williamson, who had undergone a biopsy, received good news: She did not have mitochondrial disorder herself, and therefore she could not have passed the maternally inherited disease to her children. She continued, nevertheless, to represent the opposite to everyone else.
And she experienced a series of major health crises herself, culminating in some seizures that, despite being diagnosed as psychosomatic, somehow resulted in her almost complete paralysis.7 It was at this point, in the spring of 2005, that her scheme fell apart. Now that she was pretending to be disabled, the defendant and her children needed 24-hour care. A platoon of supporters began coming into the house to cook and clean for Laurie. With these kind-hearted women feeding the children and making sure Chrissy had plenty of formula in her feeding pump, the Williamson children thrived at long last. Chrissy, a 5-year-old who wore size 18 month or 2T clothing, doubled her weight, gaining 25 pounds in six months.8 It became impossible to hide the fact that the kids were not disabled and did not need all the expensive medical equipment that Williamson had obtained for them.
The defendant, however, was still trying to raise funds, soliciting TV shows like “Extreme Makeover: Home Edition” and others to build a new house. Donations poured in as generous people offered to pay bills. Concerned that the government might see the donations as income and cut off her disability benefits, the defendant asked one supporter, Paula Pedrick, to open a second, secret bank account in which to hide cash contributions. Alarmed and uncomfortable, Pedrick refused. As the inconsistencies and lies piled up, some of the women began comparing notes. Finally, a few of them, led by Darcy Wall, approached Laurie with a proposal: Laurie should select a “wisdom team” of people she trusted. They would organize help in the home, provide emotional support, and assist in raising and directing funds. All they asked in return was financial transparency and accountability. Laurie refused.
Shortly thereafter, Susan Owen, a nurse for the Williamson family pediatrician and longtime friend of Laurie, visited the house for the first time in several months. Her friendship with Laurie had cooled recently as Susan saw things that disturbed her. Now she was astounded to see Tom and Chrissy, who were supposed to be wheelchair-bound, running and playing. With the help of their physical therapists and without their mother around to hinder and undermine them, all three children had made progress by leaps and bounds.9 Susan realized at long last that her friend had been lying to her. A few weeks later, she and Darcy went to the police and set in motion the string of events that led to the trial.
At the trial, the trial judge allowed the jury to see the big picture, including extraneous offenses and bad acts the defendant had committed against all three children, as proof of her motive to make the children sick.10 The State’s experts testified that the children were the victims of MCA, that the surgeries were medically unnecessary, and that they fit the legal definition of injury to a child. Even the doctors who had prescribed and performed the surgeries acknowledged that they would not have done so knowing then what they knew now. The experts further testified that Williamson had simulated cyanotic episodes in Chrissy by smothering her when she was just six weeks old, and that, essentially, she had used the health care system to torture her children.
With the help of Juan DeAnda, a graphic artist in our IT department, I created a timeline, based on the chronology of events spreadsheet that represented all of the nearly 600 medical contacts for the Williamson family from the birth of each child. The timeline chart vividly illustrated how the contacts increased in frequency as the years passed, especially after Chrissy’s birth in 1999 and Laurie and her husband’s separation and divorce in 2000. (The couple separated in 1999, and she did not allow him to see the children.) In 2001, when the surgeries in question had taken place, Tom had spent a total of more than two months in the hospital. The hospitalizations and office visits had continued, usually at least one per week, until 2005, when they abruptly tapered off after Laurie Williamson’s supposed medical problems began. In March 2006, I noted the removal of the children by CPS with a bold, red line. In the two years since their removal, the children had combined for a grand total of four office visits to doctors, three of them for routine checkups. The point was obvious: Therapeutic separation had worked. The children were completely healthy.
At last, after nearly a month of trial, it was time for the jury to decide the case. Following about seven hours of deliberation, the jury convicted Williamson of both cases of injury to a child for the g-button and VNS surgeries performed on Tom. During closing argument on punishment, I appealed to the jurors not to give Williamson a “mother’s discount” just because she had harmed her own children. My fellow prosecutor Kate Dolan pointed out that the scars the abuse had left on the outside of the children were nothing compared to the scars it had left on the inside, that they would be dealing with the trauma of the abuse for years to come.
I also reminded jurors of the testimony from the trial that neither MCA, MSBP, nor any of the other acronyms they had heard about represented any kind of mental illness. Many people assume that anyone who harms their own children must be “crazy.” But Laurie Williamson had been evaluated multiple times by psychologists and psychiatrists and had been found completely sane and mentally competent. Even her own experts agreed she was rational, intelligent, and free of any psychosis or mental disease. Whether you called it medical child abuse or Munchausen Syndrome by Proxy, the conduct was simply another form of child abuse. Like other MCA perpetrators, Williamson knew exactly what she was doing but chose to engage in the behavior to satisfy her greed.
The jury returned a verdict of 15 years. Undoubtedly some of the women who had trusted and supported Williamson over the years were disappointed in the verdict and thought she deserved more time—15 years seemed a paltry sentence compared to the years she stole from her children. Instead of a time filled with joy and wonder, the Williamson children spent their childhood filled with tubes, wires, needles, and the hopeless, looming prospect of an early death. But I reminded Darcy, Susan, Paula, and the others that, had it not been for their courage, the Williamson children would still be in that house today. And I told myself that with no criminal history, Williamson was parole-eligible—and somewhat sympathetic because she sat in court in a wheelchair.
And with an affirmative deadly weapon finding, Laurie Williamson will have plenty of time in prison to reflect on that fact. ✤
Endnotes1 “Medical Child Abuse” is a term coined by Dr. Carole Jenny, a noted pediatrician and child abuse expert. Both MCA and PCF are diagnoses made in children exclusively, as opposed to MSBP and FDP, which contain psychological components relating to motivation and are sometimes (confusingly) used to diagnose perpetrators.
3 Munchausen’s Syndrome is defined as the intentional exaggeration, fabrication, or induction of symptoms by a person in themselves to receive unnecessary medical treatments.
4 Tex.Pen.Code §1.07(46).
5 While there is no evidence to suggest Williamson was ever a victim of domestic violence, she frequently claimed to be the victim of physical, sexual, and emotional abuse at the hands of various people, including her ex-husband, parents, and sister.
6 The letter was never sent due to school administrators’ concerns about liability.
7 Multiple witnesses saw Laurie Williamson using limbs she earlier had claimed were paralyzed, and a lengthy EEG during her hospitalization detected no seizure activity. During one supposed seizure, a friend who was present asked a nurse at Williamson’s bedside if she was going to do anything to help her. “She’ll breathe when she needs to,” replied the nurse and walked away.
8 Chrissy weighed 15 pounds on her second birthday. Experts testified that, with a feeding pump to regulate her nutrition intake 24 hours a day and in the absence of a metabolic disorder, the only explanation for Chrissy’s small size and failure to thrive was that her mother was starving her.
9 The therapists testified that the children consistently behaved worse when the defendant was around, and that, rather than excited, the defendant appeared unhappy when they reported the achievement of a goal or milestone, often making the excuse that the child was “having a good day” and minimizing the progress.
10 Austin v. State, 222 S.W.3d 801 (Tex.App.—Houston [14th Dist.] 2007); Reid v. State, 964 S.W. 2d 723 (Tex.App.—Amarillo 1998).