DENVER (AP) — Olivia Gant's mother brought her to the emergency room when she was 2, saying the girl was having trouble eating.
Kelly Turner, who had recently moved to Colorado from Texas with her three daughters, told the doctor she had problems nursing and other complications feeding Olivia since she was born.
Over several years, Turner would often tell doctors her daughter was sick. Olivia had surgeries, took medication for a condition she didn't have and later died, a tragic end to what psychiatrists say was her mother's apparent masterful scheme to dupe medical professionals.
Now, Turner has been charged with murder, raising questions about whether the hospital did enough to protect Olivia and underscoring how much doctors rely on parents' word as they care for children.
At the first ER visit, a doctor thought the girl appeared to be growing normally. But the next year, a surgeon at the same hospital removed part of her small intestine and inserted a feeding tube.
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By 2017, Turner was presenting her daughter as a dying girl with a host of diseases and a bucket list of wishes, seeking donations to help fulfill her dreams of catching a bad guy with police and being a firefighter. The Make-A-Wish-Foundation threw a "bat princess" costume party at a hotel that cost $11,000.
That year, doctors at Children's Hospital Colorado found that the 7-year-old was only getting 30 percent of the nutrition she needed.
They couldn't persuade Turner, described by one doctor as a "high maintenance mother," to try anything besides artificial feeding. She insisted her daughter enter hospice care, where Olivia died in 2017.
Olivia's cause of death originally was listed as intestinal failure, but an autopsy done later found no evidence of that condition. Authorities have not said what killed her, but the indictment revealed this week says that doctors went along with Turner's push to stop feeding her daughter.
Along the way, Turner's behavior raised suspicions. She continued to give Olivia seizure medication with serious side effects after doctors found she had no seizure condition and insisted she stop.
Only after Olivia died and Turner brought an older daughter to the same hospital with bone pain did doctors take a closer look.
They found news stories and online posts where Turner talked about diseases Olivia had that were not backed up by medical records. Turner claimed on a blog and a GoFundMe site that her daughter had a seizure disorder, a tumor and a buildup of fluid in the cavities deep within her brain.
Doctors contacted social workers, who launched an investigation that led to exhuming Olivia's body. Her older sister was separated from her mother and has not had any pain since, according to the indictment.
Psychiatrists say Turner's behavior seems consistent with Munchausen syndrome by proxy, a psychological disorder in which parents or caregivers seek attention from the illness of their children or dependents and sometimes cause them injuries that require attention.
Turner brought up the disorder on her own during an interview with investigators and denied that she had it.
A public defender representing her did not return a call seeking comment on the 13 criminal counts against her, including murder, child abuse, theft and charitable fraud. Public defenders typically do not speak to the media.
Experts said Munchausen by proxy cases are not easy to detect.
Pediatricians are taught to listen to what parents report about their children and address their concerns, not suspect them of wrongdoing, said Marc Feldman, clinical professor of psychiatry and adjunct professor of psychology at the University of Alabama.
Dr. Khalid Afzal, an associate professor of psychiatry at the University of Chicago who helps investigate suspected Munchausen by proxy cases at the school's children's hospital, also cautioned against blaming doctors.
"I don't blame anyone who misses it because it's a diagnosis of deception. It will present differently next time," he said.
Children's Hospital Colorado said it declined to comment to avoid compromising the case.
The best way to check out suspicions is some detective work, not medical tests, Afzal said. His team will request previous medical records and have someone pore over them.
Feldman said Olivia might have been saved if her previous medical records were requested, but he acknowledged that's not a common practice because doctors are busy and not paid to review outside records.
Parents with Munchausen by proxy, which is also lately called medical child abuse, may refuse to give their consent to transfer records or claim they have been lost, Feldman said. That can raise a red flag.
Other potential warning signs include moving, switching doctors and insurance companies, and after death, seeming fascinated with mourning and funeral rituals, he said.
While the condition is thought of as rare, with an estimated 600 to 1,200 new cases each year in the U.S., Feldman believes it is more common but often goes undetected, let alone prosecuted.
Between 6% to 8% of cases published in medical journals involve deaths. They often involve more than one child in the family, but Feldman pointed out that published cases tend to be more serious.
"This was a domineering mother who coopted the medical staff. She must have been extremely skilled at lying for her to get away with it to the point of the child dying," he said.