Mother found guilty of murder for daughter's diabetic death

[Ellen]

I don't know how many of you have followed this trial, but I am worried that this trial has set a very dangerous precedent. Will every parent who now brings their child to the hospital sick in DKA be suspected of providing inadequate care?

Mother found guilty of murder for daughter's diabetic death
http://www.courttv.com/graphics/13th/shim.gif A jury found Cheryl Botzet guilty of second-degree murder in the death of her 11-year-old diabetic daughter. By Chris O'Connell
Court TV

LAS VEGAS — After deliberating for just over two hours on Tuesday, a jury found Cheryl Botzet guilty of second-degree murder for the death of her 11-year-old diabetic daughter Ariel. Botzet, sitting alone, visibly shook and wiped away tears as she watched jurors enter the courtroom.

As the verdict was read, Botzet shook her head and sobbed. In the gallery, Randy Botzet, Cheryl's ex-husband and Ariel's father, looked relieved, as did several other family members. Jurors had a choice of first-degree murder, second-degree murder, or manslaughter when they received the case after closing arguments Tuesday afternoon.

A second-degree murder conviction indicates jurors believed Botzet, 39, is guilty of killing Ariel by neglect, rather than abuse.
Murder by neglect means that Ariel died as a result of her mother's failure to properly monitor the child's insulin levels until they reached dangerous, and eventually deadly, levels, but that her actions were not premeditated or malicious.

During the week-long trial, Botzet was free on $35,000 bail. After the verdict was read, Judge Sally Loehrer denied the state request to have Botzet immediately remanded into custody and allowed her to remain free until her sentencing in December.

Though she walked out of the courthouse Tuesday evening, Botzet now faces 10 years to life in prison. Prosecutor Vicki Monroe said she will seek the maximum sentence at Botzet's sentencing hearing in December.

Botzet brought Ariel to a Las Vegas medical clinic on the afternoon of Feb. 6, 2004, after the child vomited throughout the previous night. Ariel died at the University Medical Center on Feb. 9 after she suffered a cerebral edema, a swelling of the brain caused by a condition known as diabetic cerebral acidosis, which stems from a lack of insulin.

During closing arguments, Monroe cited several occasions when Botzet was taught by doctors and nurses how to monitor and keep Ariel's blood sugar at healthy levels, and to call a doctor if they weren't normal. Because Botzet failed to seek medical help in time, Monroe said, Ariel, though still conscious and breathing when paramedics brought her to the hospital, was as good as dead.

"This child was in her final hours. This child was out of control, and the only parent responsible for her care was her mother. There was nothing that medical personnel could do to save her life," Monroe said. "Ariel Botzet did not have to die and that's what's so tragic in this case."

But defense attorney Herb Sachs ridiculed the state for even bringing charges against his client. Botzet, he said, did everything in her power to save Ariel's life. "Could she have miscalculated? Yes. Negligence? No. Abuse? No," Sachs said.
In the end, jurors decided that the state could not prove Ariel's death was premeditated. But his attempts to convince them that Ariel died because of faulty medical care or that because Clark County Coroner Dr. Larry Simms effectively retracted (http://www.courttv.com/trials/botzet/102005_ctv.html) his ruling that Ariel died of chronic neglect were less successful.

After the verdict was read, Sachs moved to have it reversed, citing Dr. Simms' testimony that he would not have ruled the death a homicide had the prosecutors provided him with extensive records of Botzet's insulin purchase in the two years leading up to her daughter's death. Judge Loehrer refused the motion.

On the courthouse steps, Randy Botzet, who testified for the state, told reporters that he was satisfied with the verdict and pleased his family could now have some closure. "There's relief in our family. I'm proud of the district attorney's office and the job they've done," he said after hugging prosecutor David Stanton. Botzet said he hopes his ex-wife gets the maximum sentence allowed under law for killing their daughter. "She deserves what she got. She did the wrong thing and now she's going to pay for it," Botzet said.

[Red (aus)]

Ariel died at the University Medical Center on Feb. 9 after she suffered a cerebral edema, a swelling of the brain caused by a condition known as diabetic cerebral acidosis, which stems from a lack of insulin.

I haven't read up on this, but I have long been under the impression that cerebral oedema from dka was caused when someones high blood sugar was reduced very quickly.

[maverickmom (Kerri)]

I'm not worried about this at all. DKA happens even under the best of care. We have documentation of taking proper care of our childrens' diabetes whereas apparently (from my understanding) this child's clinic had concerns about her diabetes care on a number of occasions, and I'm sure that was documented in her charts. Apparently many other people had concerns as well, and social services had even investigated at times. It doesn't sound like a typical scenario to me so I don't feel it sets a precedent for the rest of us.

[cydnimom]

I agree that this case doesn't just come from a single incidence of not caring about her child's diabetes. I believe there was some history of neglect and not being able to find your child's supplies during a move is no excuse for me. I wish they would have put her on the stand or called some of their own witnesses. It would have been nice to hear her side of the story, plus I think it makes her look even more guilty, although what she might have had to say may have made it worse.

[Ellen]

She may have been too emotionally upset about it all to testify in her defense properly. The fact that she didn't testify does not make her guilty. She was originally charged because they said she didn't purchase enough insulin and later they proved she did purchase enough insulin. She did admit in an interview that she wished she knew more about diabetes. Not every parent has the ability to have the extensive knowledge that many of us proactive parents have. Though none of us wants to believe it, DKA can and does kill, even those who are under good control with great parents.

[Sweetkidmom]

I have to admit this case made me worried. I know little about it, other than what I gleaned from the 'Net. I got to thinking that if *I* were to be investigated, how would I "prove" that I had taken care of my Jess? What would constitute "documentation of taking proper care"? The pharmacy send me insulin (and pump supplies) every month by post, but that doesn't prove I'm using it. I haven't kept a log book for almost a year, as her doctor downloads her meter results now and prints everything out with a wonderful program that shows trends etc. How does one "prove" that one is an adequate mom?

Kay
(who already feels guilty because she suffers from depression)

[maverickmom (Kerri)]

I don't know if diabetes clinics have official criteria they follow, but I've been in the diabetes clinic a couple of rare times when our endo was tempted to call CPS on a family (he doesn't tell me who these families are, of course, and there are only a few families out of about 120 or so, so obviously what they do or don't do stands out and sends up red flags to the clinic). From what I gathered, the families in question had a history (key word here being history, not just happening once or twice) of doing stuff like consistently not keeping appts and/or not rescheduling missed appts and/or letting the dr know why the appt was missed etc (sometimes it is unavoidable and scheduling conflicts arise, and that is recognized). They were also consistently not doing what the clinic asked the parent(s) to do (like send occasional bgs or coming in more often if requested by the physician - he only has kids come in more often than quarterly if there is a problem or the control is very bad). Basically, they weren't doing things that a typical responsible parent would do and were basically blowing off the clinic and/or diabetes care (indifference, noncompliance etc. Not your typical parent.) Notice that nowhere did I mention A1c levels. Our endo has never once mentioned calling CPS on someone whose kid had an elevated A1c...I've only heard him mention the irresponsible stuff. Most of us would not fall into the that category (even if at times we feel like failures at this D thing or delay an occasional appt etc. Even parents who only come to the clinic twice a year do not fall into the neglectful category. There is obviously more to it than that, and the history is key.) This stuff does get documented in the medical chart, at least at our clinic.
From what I remember from this case when it first came out, this family had a documented history of noncompliance. Anyway...I'm not worried.

[Ellen]

Dec. 06, 2005
Copyright © Las Vegas Review-Journal

New trial ordered for mother convicted in daughter's death

By GLENN PUIT
REVIEW-JOURNAL




Cheryl Musso appears in Clark County District Court on Oct. 25. She will get a new trial.
Photo by K.M. Cannon.



Ariel Botzet
Girl, 11, died after suffering swelling of the brain caused by a lack of insulin

A woman convicted of killing her 11-year-old daughter by depriving her of insulin will be given a new trial after the case judge on Monday ruled she erred during trial by allowing improper testimony to come before the jury.

"I'm elated, and it is the first time I have seen justice in my instance prevail," Cheryl Musso said in a statement released by her attorney, Herb Sachs.

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But Musso's ex-husband was aghast at the decision Monday from District Judge Sally Loehrer. Randell Botzet noted that just a little more than a month ago, 12 jurors sat through a two-week trial and unanimously convicted Musso of second-degree murder in the death of her daughter, Ariel Botzet.

"Nice system we have, isn't it?" said Randell Botzet. "I think it's a bunch of (expletive.) How can you just overturn the jury's decision like that?"

Loehrer granted Sachs' motion for a new trial because, she said, she erred in allowing witnesses to testify that Musso had not been adequately caring for her daughter's diabetes in Colorado.

The judge said the testimony regarding events nearly four years before Ariel Botzet's death was too prejudicial.

Clark County prosecutor Dave Stanton vowed Monday to file an immediate appeal to the Nevada Supreme Court.

"How she (Loehrer) can make that ruling based on the facts of this case are utterly shocking to me," Stanton said.

"I don't think there is a basis in the facts or the law for it, and I believe the Supreme Court will overrule her decision," Stanton said.

Ariel was taken by her mother to a University Medical Center Quick Care, then rushed to an emergency room in February 2004. The child suffered from severe swelling of the brain caused by a lack of insulin, and she soon died.

Ariel was first diagnosed with juvenile diabetes at the age of 3. Witness testimony indicated that after the diagnosis, Musso received extensive training on how to monitor their daughter's blood-sugar levels and also how to inject the insulin.

Randell Botzet testified during trial that Musso disappeared to Utah in 2001 with the couple's two children. She later returned, then disappeared again to Colorado.

During Musso's trial, nurse practitioner Molly-Jane Bangert said tests on Ariel Botzet also showed her blood sugar levels were way too high.

"She said that she didn't need anybody to tell her how to take care of her daughter's diabetes," Bangert testified.

Bangert said she retrained Musso on how to care for her daughter's condition.

Loehrer said testimony from Bangert and others from Colorado was too prejudicial. She was under the impression before trial that the Colorado witnesses were going to only testify that Musso was trained in handling diabetes, but they ended up portraying Musso as someone who had neglected her daughter's condition.

Sachs said Monday Loehrer's ruling to reverse the conviction was the correct one.

"The only ones who testified to any supposed neglect were the Colorado witnesses, and that was four years before she died," Sachs said. "What happened in Colorado four years before did not contribute (to the death). It had nothing to do with it."

But Stanton said the testimony of the Colorado witnesses was relevant because Sachs had argued during trial that Musso stockpiled insulin. The testimony from the witnesses, he said, showed this wasn't the case.

"It directly rebutted the defense's claims," Stanton said.

Musso faced a potential prison sentence of either 10 to 25 years or 10 years to life. No new trial date has been set yet because Loehrer put all proceedings on hold pending a review from the Nevada Supreme Court.

[margaret]

Hi Ellen, I followed thIs story that aired on Dateline and was horrified, as I was accused of medical neglect of my child in 2002. I have since proved it was a retaliatory tactic used by the local school district. While I can relate, I questioned the mother's abilities in diabetic care and what infurated me was prior to death the child had spent time with the father and he did nothing about her illness. As I am sure you can well imagine, the ramifications of the false accusation have been great! Just because there was of course no indicators of neglect, I was supposed to be happy. The State of Florida keeps all persons accused of abuse or neglect on a registry, founded or unfounded. Probably because they cannot keep track of the children in foster care. While child abuse is a real thing, I told the State that we would never win the war on child abuse unless we first win the war of false allegations. Who could imagine diabetes could destroy a families life, after all it hasn't been the diabetes that cannot be managed but the laws!

Margaret

[Momof4gr8kids]

Wow, that could start a scarey standard for all of us. Julia, luckily has never been in DKA, but I assume that is because we caught it early, and have been honeymooning ever since. We have had ketones when ill, but we kept in close contact with our endo. I wonder what they would consider neglect. By these terms it is if your child has any complications, as no one from recent years could say that she was neglectful, and where was the dad, why was he not taking care of his daughter if the mom was doing so bad at it? Sometimes you can try your hardest, and check blood every two hours, and still not be able to control this disease.

Margret, I am so sorry that you had to go through proving a false claim. Specially against the school. I hope that someday they gather facts first, and then take action.

[margaret]

Hi Jamie, Thanks for your understanding. My head pounds constantly because for the past almost 6 years we have lived a nightmare here in Martin County, Florida. Tomorrow will be another struggle, the private school my son is now attending refuses to accept physicians form and nothing is in place for diabetic episodes. Luke, my son tends to his own needs but honestly, all I ask is for no imminent threat to his safety and his teacher refused to conference with me on Friday. It's the ignorance that is so dangerous!

Margaret

[zimbie45]

Isnt this the case that was on date line at the begginning of the year,, if so there is much more to this..like the mom didnt buy insulin, the girl lost her BG monitor months ago.. when she started to get sick, a nurse from down the road who was alsop diabetic gave her a monitor and a bottle of insulin.. the girl only had a few finger pokes in the few weeks befor her death.. i will try to find the date line story...

[zimbie45]

here is the orginal story in jan/06

http://www.msnbc.msn.com/id/11092139/

[diamondback688]

i didnt know anything about this case until i read those 2 articles here...i would seek the maximum possible sentance...she deserves it IMHO...she killed her daughter(i wont say murdered, because they proved it wasnt premeditated)...

[madde]

This case is a hard one to comment on.

All I can say, is I wouldn't allow my diabetic daughter go ALL NIGHT and half the next day vomiting with diabetes. She would've been taken to the emergency room within a few hours of vomiting. There is a point in which OUR care for our children becomes inadequate and we need to use "good judgment" and get them to a hospital promptly.

Based on that, I don't think she was taking "GOOD CARE" of her daughter during her illness.

[twicker1]

I don't remember all the details, but I did watch it when it aired. At first I was terrified and wondering how this could affect us if something happend to Brandon. Then after watching it, I think there were just too many things that were done wrong. Even without D, I would have taken my child to the ER by then. I don't remember them saying they lost her meter, although maybe they did, but remember them saying something about only having a couple of testings in the memory of the meter for a 7-9 day period.

[hallenbeckfamily]

I agree with Elizabeth. I would not let Chris go a day with flu without out either calling Endo or going to ER. I made him go for lab work just cause he was peeing alot for petes sake,thats how this all came about. I certainly would not let the flu go by with out a Dr visit. The flu is way bigger esp now we know he has D. He has a cold and I finger poke all the time to monitor his bg's. I don't understand why that mother,according to article, had not checked her daughters bg's in like 4 days WHILE she had the flu? It boggles the mind. I have days where I'm sick of it, esp in the middle of the nite, and I pull covers over my head at 2 am and say NOOOOO, I'm tired!!!! But HELLO, I get up anyway and check him,its his life. You don't mess around with it. Anyway, just wanted to say I don't get it, it does SUck big time but its what we have to do and we just DO IT. No matter what. Jennifer

[EmmasMom]

*Warning!! Rant ahead!

I agree that the mother in this case was negligent, but a criminal... I'm not sure it's that black and white.
It seems that there were numerous findings like, there were only a few test results on the one meter the prosecutor had as evidence, but there were actually several meters in use. The insulin Rx hadn't been filed w/ insurance recently because the mom was buying mail order insulin for less than her copay. The daughter actually spent the day prior to her death with her father, and though she was obviously sick and vomiting he did nothing and took her back to her "negligent" mom :confused:, (he apparently has no responsibility in this, and no idea about ketones either???). The allegations of poor diabetes care were 4 years old. The symptoms of DKA and a flu are very similar and w/o ketone testing you might never know the difference. Many people, including several posters I've seen on this site don't know you should always test for ketones during vomiting, (no matter what BG is) this is not always common knowledge. She was 8 years into this, and it's very common for people to become lax about their care after many years, sad but very true. The child was 11, why didn't she test her own blood sugar? Many kids are taking a lot of responsibility for their D care at age 11, but Mom is still 100% responsible for everything they do... scary thought.
I also believe that A1C changes can happen faster in kids than adults because kids renew their cells more frequently, so her high A1C could be a result of a few weeks of really bad numbers along with generally bad control, rather than 3 full months of horrible control. I've seen Emma's A1C change from 7.8 to 9 after a few weeks of being sick, and that's with a pump and 15 tests a day, (and a very neurotic diabetes control freak mother :rolleyes:) If she was on NPH being tested only a few times a day her A1C could've been 14, 15... who knows?

Anyhow... I'm not saying she did a good job, I think she did a really bad job. But I think a lot of people do a really bad job at parenting, and at managing all kinds of illnesses. Most people, (not those of us around here ;)) do a pretty bad job of managing diabetes, why do you think almost everyone ends up with complications. It's easy to be perfect for a while, (and according to testimony she was too, at first) but after 8 years of 24/7 care, and other family issues, and an ugly divorce, and I'm sure numerous flus and stomach bugs that all ended fine... she missed this. Stupid... yes, criminal...??? People die everyday because their diabetes is out of control, lots of them!

I agree with Ellen, it sets a scary precedent for parents of chronically ill and particularly diabetic children. What if a child dies from hypoglycemia and mom didn't have the glucagon with her, we know we should always have it, we've been trained to carry it, it's irresponsible, maybe even negligent to run out of the house and forget it. But it could happen. What if you're exhausted one night and skip a midnight test only to find the pump site fell off 12 hours earlier and your child is now in DKA? What if you decide your 11 yr-old child is responsible enough to manage their diabetes most of the time, (another thing I've heard on this site) but you're wrong??

I just think there are a lot of gray areas in this case, and it's pretty scary to think what might happen if you had to prove to a jury (of typical people that are absolutely clueless about type 1 diabetes) that you did the best you could. Scary stuff!!!:eek:

[melissabeth]

This whole story is so sad and confusing. But I'm going to add my two cents by ranting about the father. So, basically, he does nothing and then jumps on the soapbox when there's a tragedy and puts all the blame on the Mom?!? Why wasn't he charged with something (neglect, at least)if he spent the day before with the daughter and was so worried about her that he did nothing. I'm sorry, but even if the mom did a crap job at keeping up with things it looks to me like she was still doing 100% more than her lazy hypocritical ex-husband. Why didn't he call social services, or try to get custody, or take her to the doctor himself?

[margaret]

While I agree the mother was negligent. the child hsd just spent time with the father. Just think it cold happen to you, it happened to me and the fact is that all that is required is a "preponderence of evidence." After living through a false allegation, I can tell you the ramifications are horrific!

Margaret
Falsely Accused!

[monkey97]

Amy, you say about not having glucagon on you at all times. I've never been told anything about taking it everywhere with me. Just to make sure we have it at home. I take plenty of glucose tabs with me, probably too many and other things for hypos, but not glucagon. Its a new one to me.

[Tamara Gamble]

Ellen, this really concerns me. I don't know what to think. I read the article that Chandra gave a link to as well. I don't know that we have all of the facts. There are definately things that raise some red flags for me though like, the fact that the woman kept saying, I'm a good mother when asked questions, or when the nurse in Colorado spoke about trying to teach her she was angry that she was being told what to do. When asked if she felt responsible for her childs death she repeatedly said no.

If my child died on my watch good care or not, I would feel responsible and remorseful for the rest of my life. I'd probably let them cart me off to prison because I would feel like I deserved the punishment even if I had done a great job managing and something just went wrong. I just couldn't live with myself. Okay, I wouldn't willingly let them take me to prison but if I was asked if I felt responsible, part of that answer would be yes for the rest of my life I will feel responsible.

Where was dad's responsibility in all of this? This whole situation seems so fundamentaly wrong. If they only had two blood tests on the meter that tells me that good old daddy didn't take care of his child bg the day before she died either. Whether It's one day or one month they are both to blame here I think.

I am angry about the whole thing. I am angry that there had to be a case like this at all. It is beyond me to understand this. It appears to me though that they don't have all of the information gathered to proceed with anything. Did she or did she not use mail order for the insulin? Did she or did she not have syringes replenished? How much was in the house of each? What about test strips, Ketostix, precision ultra, any other supplies?

What about the school? Didn't they follow a regimine for this child or was she home schooled? I am at an utter loss here. Things are not clear. Was it due to the child cheating? If so why wasn't a pump ordered for this child by the clinic so that she could eat what she wanted? I just can't figure it all out based on the information given, how could a jury know if I have a child with D and I don't know.

People are falsely accused sometimes. Sometimes someone took to long to step in on a childs behalf. Sometimes a child gets lost in a messy divorce and people are so busy arguing and wanting to place blame when both parties are responsible. It seems as though this father has a false sense of security in all of this. He should be held accountable as well, given the fact that the child was with him also and he did nothing.

People are so moraly bankrupt anymore it makes things so unclear. I do wonder about the school part. What do they have to say about the childs care. They should know. Was she testing at school? Where the supplies there? Where is that meter? Yes she was home at this point but what about before.

I also feel a bit of apprehension. I do change basals and I to C ratios and correction factors. I also test through out the night though. But now I'm feeling a little scared. I know that I would not knowingly do something wrong but what if I did? What if it killed my child. I am really freaked about this whole thing. I do have permission from our endo to make the adjustments because of my understanding but what if I was just wrong?

Please let us know how all of this plays out. I like that you keep us informed. I hadn't heard of this case before. Although deeply disturbing I think it's important that we know the happenings.

Tami

[wendyc]

Society failed this child. Yes, the parents were at fault for not properly caring for her, but what about others around her? There had to be extended family members who knew of her having D, what about school? Or her ped?

This is a perfect example of a child slipping through the cracks, and there were many people around who could have put there hand out to help her and for one reason or another they didn't.

[Ellen]

No one knows all the details. Here's a hypothetical, what IF, the hospital messed up when trying to get the child out of DKA? Do you think they would admit it?

[melissabeth]

Good point, Ellen. Once it becomes a criminal issue everyone has to cover their own butts. As far as the mom saying that she didn't feel responsible, that sounds like lawyer-talk to me. I'd bet a million dollars that she feels absolutely wracked with guilt about the whole thing, but her lawyer probably told her that if she wanted to stay out of jail she had to answer that way so the prosecutors wouldn't twist it around to make it sound like she was admitting it was all her fault. (This is, of course, pure speculation on my part).

[Tamara Gamble]

What a shame. In life she fell through the cracks and in death no one can be responsible either.

Tami