In Great Britain, meanwhile, Münchausen-by-proxy prosecutions — and Roy Meadow's reputation — took a hit after three high-profile convictions achieved with the aid of his testimony were overturned during the past decade.

The Pickenses are a devoutly religious family. "Kheematah used to say, 'Come on, Mikal, fall and shout now! Let me bring you back from the Spirit! Let me put my hands on you!'" recalls Flora Lee, a close friend of the family who visited the children during their hospital stay. "And when they would play, they would pray for you," Lee adds. "They were real happy. Mikal and Kheematah loved each other, baby."

When Mikal died, donations from members of at Karl and Judy Pickens' church, Trinity Full Gospel Church in the Baden neighborhood of north St. Louis, helped the family lay out the boy in a small wooden casket. He wore a white suit.

Judy Pickens' booking photo, February 2006.
Judy Pickens' booking photo, February 2006.

The Pickens entourage had maintained a rotating vigil at the hospital throughout the children's stay, with some family members so reluctant to leave that they slept in the parents' lounge. Of particular note was Judy Pickens, a constant presence who slept in the children's room, bathed them and changed their bed linens.

The staff was impressed by Pickens' devotion.

"It was exciting for us to have a parent who wanted to clean up after their child and be so involved," Becky Stolle, a registered nurse who helped care for Mikal and Kheematah, would recount in court testimony.

But opinion of Pickens among the personnel began to change in the hours after Mikal's death. The first sign of something amiss came when Dr. Margaret Schmandt, the family's pediatrician, got word of Mikal's death and rushed to Children's Hospital to check on Kheematah. She found Stephanie Finch, Judy Pickens' cousin, at the girl's bedside.

"[Finch] went and pulled some IV tubing out of Ms. Pickens' bag," Schmandt would later testify. "She told me Ms. Pickens had told her that the previous day, Mikal's IV wasn't working, she had called the nurses to look at it and they had seen a white substance in it."

Finch told Schmandt that after watching the nurses throw away the faulty tubing, Pickens had fished the apparatus from the trash and stashed it in her bag. Finch gave the tubing to Schmandt, and it was sent along with Mikal's body for an autopsy.

When the medical examiner's office was unable immediately to determine the cause of death, hospital and police officials were alerted that toxicology tests would be necessary, and after Kheematah Pickens was transferred back to a regular room from the ICU, a nurse's assistant was assigned to her bedside 24/7.

On October 16, 2004, Children's Hospital barred Judy Pickens from her daughter's room. A week later, the little girl, healthy again, was discharged into the care of her paternal grandmother.

Meanwhile, police and forensic examiners had initiated an extensive inquiry.

Detectives interviewed personnel at the children's schools and learned that, contrary to what Judy Pickens had told doctors, no flu bug had been going around.

At Pickens' workplace, colleagues told police that Pickens said she'd earned graduate degrees and a CPA's license from Saint Louis University and Washington University. The claims proved untrue; police learned that Pickens had not attended either school. Detectives also learned that Pickens was arrested in 1997 for making a bomb threat at Bank of America, where she worked at the time. (Prosecutors had not pursued charges.)

But it was the dozens of medical personnel involved in the Pickens case whose testimony would shed the most light on the children's poisoning.

On October 13 the nursing assistant on duty at Kheematah's bedside, Natalie Sommers, had reported two curious events that evening. According to Sommers' subsequent court testimony, Judy Pickens had insisted that Kheematah needed a drink and, over the assistant's objections, had tried to make her daughter swallow Sprite from a blue paper cafeteria cup.

Kheematah recoiled at the flavor. As Sommers put it: "She said, 'It tastes gross.'"

After Kheematah accepted a drink offered by a different visitor, Sommers said, Pickens became more insistent about making the girl drink from the blue cup.

Later Pickens asked Sommers to help her remove a glass angel hanging from Kheematah's IV stand. As Pickens reached for the ornament, Sommers saw a syringe drop to the floor. Testified Sommers: "She quickly covered it with her foot."

The women's eyes met, but neither mentioned the syringe. "I didn't want to let her know that I saw it drop, because I didn't want her to do anything to Kheematah or me," Sommers later stated. Instead, after Pickens left the room, Sommers summoned several nurses and showed them the blue cup, which contained a small mound of white sediment.

Pickens later returned to the room frantic, asking for the tray on which she'd left the cup of Sprite, according to Sommers.

The medical staff had already confiscated it.

The following night, October 14, another assistant, Tara Owens, was on duty in Kheematah's room when Pickens pulled the privacy curtain in order to change the girl's diaper. Owens would later testify that after muttering that Kheematah's IV line was tangled, Pickens had stooped at the bedside as if to straighten it out. "She got up and said, 'I can't fix them, so they're just gonna stay like that'...[then] walked to the trash can and dropped something in there," Owens stated.

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