The trial of a Balgownie mother accused of causing the death of her "chronically ill" two-year-old daughter by failing to get her medical treatment has begun in a Sydney court.
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The woman, who cannot be named for legal reasons, broke down in tears as details of the child's deteriorating health and ultimate death in early October 2009 were revealed by Crown prosecutor Huw Baker to the court on Thursday.
Mr Baker said an autopsy found the child was suffering from several internal injuries at the time of her death, including a severe case of blood poisoning, organ failure and a large tear in her small intestine, which had caused peritonitis.
A forensic pathologist attributed the injuries to "blunt force trauma ... to the abdomen", estimated to have occurred sometime between four and eight days prior to death.
The child was rushed to Shoalhaven Hospital just after 10am on Sunday, October 11, after the mother and her partner found the girl unresponsive on the couch while staying at a relative's home near Nowra.
Paramedics and doctors desperately tried to save the toddler, but she was pronounced dead an hour later.
In court on Thursday, the woman pleaded not guilty to a charge of manslaughter by gross criminal negligence.
Mr Baker said blood tests taken at the time of death and during the post-mortem examination confirmed the girl's illness was "a chronic one".
He said the court would hear that the child had been vomiting, had diarrhoea, was lethargic and at times refusing to eat in the seven to nine days before she died.
A doctor called to the house on October 5, diagnosed the child with gastroenteritis with mild dehydration, and told the mother to make a follow-up appointment with her regular GP and buy medication for stomach cramps.
However, Mr Baker said no such appointment was made and the mother did not buy the medication for another four days.
Meantime, the child's step-grandmother, who looked after her with the child's maternal grandfather two days later, told police she was immediately concerned about the toddler's health when she arrived at the house. Later that day, she tried to take the child to the doctor but, not knowing the area, became lost and missed the appointment.
The woman urged her step-daughter to get the child medical attention, saying she feared the girl may have childhood diabetes, however, the mother did not adhere to the advice, instead taking the child to McDonald's on Thursday.
The day before her death, the toddler was lethargic, refusing to eat and drink, and twice vomited brown liquid, which the mother put down to her eating Nutri-Grain for breakfast. The court heard the mother considered taking her daughter to hospital that day but decided against it because she "looked so peaceful" sitting on the lounge and the woman "didn't know Nowra that well", Mr Baker said.
The child woke on Sunday morning and resumed her seat on the lounge, however, when the mother's boyfriend tried to rouse her just before 10am, she did not respond and was found to be unconscious and not breathing.
"The Crown case is that the symptoms in the last days before the child's death were so serious and obvious that any reasonable person would have realised that there was clearly something very wrong with her and she required medical intervention," Mr Baker said.
However, defence lawyer Cathy Doosey claimed the evidence before the court would reveal her client was "a bereaved mother whose child died through no fault of hers".
The trial is being conducted without a jury, in front of Judge David Frearson.
