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Like a gavel echoing for a second time, a Florida appeals court on Monday refused to revisit its decision undoing a $213 million verdict against a St. Petersburg hospital in the closely watched case tied to the Netflix documentary “Take Care of Maya.”

The Florida Second District Court of Appeal denied a request from Maya Kowalski to reconsider its October ruling that reversed the massive judgment against Johns Hopkins All Children’s Hospital. The earlier decision wiped away a jury award that had favored the Kowalski family, who say hospital staff’s handling of Maya during a three-month stay beginning in late 2016 contributed to the suicide of her mother, Beata Kowalski.

Appeals Court Holds the Line

Immunity Ruling at the Core

In its October opinion, the appellate court concluded that the trial court properly granted the hospital immunity under Chapter 39 of Florida law, which protects good-faith reports of suspected child abuse. But the panel said the trial veered off course when jurors were exposed to what it called “significant and inflammatory testimony” about restrictions imposed by the dependency court after Maya was removed from her parents’ custody and required to remain at the hospital.

While the court acknowledged that statutory immunity does not shield bad-faith conduct, it said the record contained no evidence showing the hospital carried out the dependency court’s orders in anything other than good faith.

“We agree that the trial court’s rulings on Section 39.203(1)(a) immunity permeated the entire trial,” the court wrote in October, ordering a new trial on all claims not otherwise resolved by its opinion.

Kowalski Pushes Back — and Is Rebuffed

Statutory Question Deemed Settled

In seeking rehearing, Maya urged the court to weigh whether Section 39 immunity should protect the hospital from tort claims a jury found were committed while she was in its custody. She framed the issue as one of “exceptional importance,” pointing to a statutory provision that withholds immunity from anyone suspected of abusing or neglecting a child or committing illegal acts against one.

The appellate court declined to reopen the issue, leaving its reversal intact.

Tragedy Behind the Case

The Kowalskis brought Maya to the hospital’s emergency room in October 2016 with severe abdominal pain. Hospital staff became concerned about potential medical child abuse after Beata Kowalski pressed doctors to administer high doses of ketamine, prompting a report to Florida’s Department of Children and Families.

Maya was removed from her parents’ custody days later and remained hospitalized for 97 days. Beata Kowalski died by suicide in January 2017.

In November 2023, a Sarasota jury awarded the family $211 million in compensatory damages and $50 million in punitive damages, finding the hospital liable on all counts. Sarasota County Circuit Judge Hunter Carroll later trimmed more than $47 million from the award but denied the hospital’s request for a new trial — a ruling the appellate court ultimately overturned.

Medical History in the Spotlight

Maya, who turned 18 in December 2023, first experienced debilitating pain in July 2015, leaving her unable to walk and reliant on a wheelchair. Doctors at several institutions suspected conversion disorder, also known as functional neurological disorder, a psychiatric condition that can produce physical pain. Testimony showed Beata Kowalski rejected that diagnosis.

Instead, she pursued high-dose ketamine treatments for complex regional pain syndrome, including a 2015 trip to Monterrey, Mexico, where Maya was placed in a ketamine-induced coma for a week.

Since leaving the hospital in January 2017, Maya has not received ketamine treatments and no longer uses a wheelchair.

What Comes Next

Johns Hopkins All Children’s Hospital declined to comment on the rehearing denial, pointing instead to an earlier statement from attorney Ethen Shapiro of Hill Ward Henderson, who said the hospital looks forward to defending its staff “in a fair trial on the few remaining claims after rigorous and proper application of immunity.”

An attorney for the Kowalski family did not respond to a request for comment.