At a five-day trial in June, Judy Pickens became the first alleged Münchausen mom prosecuted for murder in Missouri. She arrived at the St. Louis Circuit Court hooked up to an oxygen tank and sitting in a wheelchair, swollen in the face and considerably heavier than when she was arrested in 2006.

In a courtroom packed with the defendant's family and friends, as well as prosecutors and social workers, Shirley Rogers, chief trial assistant for the city's Circuit Attorney's Office, called 47 witnesses to testify for the state. It marked the first time in twelve years that Rogers had tried a case before a judge.

Rogers traced the course of Mikal's and Kheematah's illnesses in painstaking detail. Witnesses revealed that neither child had ever been prescribed clonidine hydrochloride, and that records showed their mother had taken the medication since 2000. Rogers homed in on the fact that Judy Pickens picked up her clonidine prescription six days before Mikal and Kheematah fell ill and that she obtained a refill of the 0.3 milligram tablets on Mikal's birthday, October 8: the day before he died.

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

Donning a latex glove, Rogers exhibited the blue paper cup Pickens allegedly admonished her daughter to drink from. According to a toxicologist, the cup contained residue from clonidine, as did blood samples taken from Kheematah Pickens on two different days.

Dr. Kamal Sabharwal, a forensic pathologist at the St. Louis Medical Examiner's Office, told the jury he detected clonidine hydrochloride in Mikal's blood and liver tissue. While that alone could have killed the boy, the insoluble binder material used in the tablets was equally lethal, said Sabharwal. "This material went into the blood vessels, and the lungs, and clogged them so no blood or air could get pushed through," Sabharwal testified. "This is the same type of thing we see in drug abusers who crush up pills and inject [them] into their veins."

Rogers offered two possible motives. Cash poor, Pickens enlisted an attorney days after Mikal died in order to sue Children's Hospital for medical malpractice and wrongful death. She may have been poisoning the children in the hope of a financial windfall, Rogers said.

Or perhaps psychologist Michael Armour, who had taken the stand, had been correct when he ticked off the telltale signs of Münchausen by proxy. "[Perpetrators] can be quite accomplished liars or manipulators," he had said. "They may seek attention from a wide variety of people. They deny all or part of their involvement when questioned. They don't stop their behavior when they're caught; they keep going when they're discovered."

Rogers concluded her closing argument by saying, "One of the last things Mikal Pickens saw was the face of a killer, and it was his mother. I think it's a pretty horrible accusation to say a mother killed her child. That's why you get proof. And we did."

Judy Pickens did not take the stand in her own defense. In fact, Tucci, her lawyer, called no witnesses. In his closing argument, he suggested the hospital was to blame, and that the staff had set out to frame his client in order to avoid a lawsuit.

"This hospital is staffed by human beings. Staffed by people. And people make mistakes. It's one of the few constants in life," the defense attorney argued.

As the jury deliberated Pickens' fate on June 19, a family member paced alone outside the courtroom. "Man, I don't know what to think," he said, shaking his head. "They all got her clothes and stuff here," he said of the Pickenses' optimistic entourage. "They're ready to take her home!"

Karl Pickens and other family members declined to be interviewed for this story. Through her attorney, Pickens also refused to comment.

After four hours, the twelve-member jury returned to deliver its verdict to a standing room-only courtroom. Gasps and quiet cries escaped from the crowd behind Pickens as St. Louis Circuit Court Judge Jack Garvey read aloud: guilty on all six charges.

Karl Pickens bowed his head on the bench in front of him and cried.

Judy Pickens faces life in prison when Garvey sentences her on August 13.

Tucci says his client intends to appeal. "Judy continues to mourn and grieve for her children, and she ultimately believes she'll be exonerated," he says.

Pickens' ex-husband Samuel Armstrong says his son, now a teenager, has not visited his mother in jail. "That's not the way he'd want to see her," Armstrong explains.

Kheematah Pickens, who has been healthy ever since her 2004 hospitalization, remains a part of her mother's life. According to family friend Flora Lee, Kheematah visits her mother in jail every Sunday after church.

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