Donella Knox: A mother forced to fight for too long
What could drive a person to kill their child? For Blenheim woman Donella Knox, it was the feeling that she was alone in a battle that would never end. Reporter Jennifer Eder pieces together the testimonies of medical professionals, friends and family, and Donella herself to reveal the story of a mother forced to fight for too long.
A letter in the mail was the final straw.
When Donella read the letter, she thought "this has to stop".
Yet again doctors could not explain why her daughter Ruby was in pain, why she woke every night in agony.
Donella had been a "strong and caring mother" for 20 years but was broken, mentally and physically.
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Later that day, she gave Ruby 20 sedative pills and held her hand over her mouth until she stopped breathing.
Surgeons, GPs and respite carers were a constant feature in Donella and Ruby's lives.
Donella knew something was wrong from the start. Ruby was a "floppy baby" who didn't reach the milestones other children did. She was diagnosed with severe autism spectrum disorder at the age of 6.
For Ruby, it meant she could not speak, she struggled to empathise, and was often aggressive without understanding the consequences of her actions. As she grew older, she was also diagnosed with a severe intellectual disability. She often hurt herself and others. She would head butt and scratch other children, and pull their hair, and attack animals.
Ruby also had spina bifida, gastro-oesophageal reflux, hemorrhoids, incontinence and chronic constipation that caused further medical problems.
Doctors weren't able to work out why Ruby suffered so many medical problems alongside her intellectual problems.
Ruby and Donella featured in a 60 Minutes television show when Ruby was 5, and again when she was 11. Donella described the daily difficulties of looking after Ruby, and how the stress affected her.
She told the presenters she had considered killing herself and Ruby by driving off a cliff. She felt helpless to stop Ruby's suffering.
Friends and family rallied around Donella after the programme aired, but Ruby's constant medical problems continued.
A spinal rod was inserted into her back when she was 13.
She had many hospital visits for fecal impaction, a complication from her chronic constipation, and treatment required her to be tied to a toilet for several hours. A surgical procedure when she was 14 involved cutting an opening in her lower abdomen through which salt water was used to flush her bowel every two days.
It was a difficult procedure because of Ruby's behavioural problems, and the opening got infected, requiring more hospital visits.
Donella, watching Ruby's behaviour closely, was convinced she was suffering chronic pain.
Doctors eventually found it was caused by spinal deformity, scoliosis, and the insertion of her spinal rod. She spent three months rehabilitating in hospital.
It helped relieve the pain somewhat, and she became less violent.
As a teenager, Ruby was able to manage at school and with caregivers, allowing periods of normality for Donella.
She did not mix well with other children and could not play with them, and was seen by other parents as a threat to their children.
Donella struggled to find respite carers who could manage the large, tall and heavy girl, who would still lash out.
Her close friend Sharna Butcher said Donella's group of friends had their own children, and they would find babysitters for them so they could watch Ruby while Donella took a break.
"But it was hard. She'd get violent, and we're not qualified carers," Sharna said.
Donella also struggled to find accommodation suitable for Ruby but did not want her daughter to be institutionalised by placing her in residential care, though she was offered a place at Trolove House in Nelson more than once.
She would become angry when the idea of residential care was brought up.
Their general practitioner said in a submission to the courts Donella was highly concerned about Ruby's welfare.
Judge Joe Williams said the GP saw them more than 150 times and got to know them well.
"In his words, she was always large and strong, weighing twice as much as a normal child her age, and controlling her during her aggressive moments was stressful and physically dangerous."
Donella always attended appointments having researched treatment options, he wrote.
"He described you as a strong and caring mother, and a constant advocate for Ruby," Justice Williams said.
By the time Ruby was 20, she could no longer be seen by the pediatric team, could not attend school and respite workers were not always able to handle her.
In the months before her death, Ruby was struggling to sleep and was increasingly physical during the night, which meant Donella was often sleep-deprived.
A MOTHER KNOWS
Donella was convinced Ruby was in great pain. She could tell from small changes in Ruby's behaviour.
She took Ruby to the emergency department at Wairau Hospital, in Blenheim, 10 times in two months.
The medical team said Ruby had behavioural problems that needed to be treated with medication. Donella felt the medical fraternity had brushed her off, Justice Williams said.
Her brother visited and said Donella was focused on trying to get help for Ruby, and would cry when she spoke about it.
It was unusual to see her cry, he said. She took Ruby to Starship Hospital for a review of her spine in February.
Surgeons agreed Ruby was in pain, but did not think it was from her back.
They sent Donella and Ruby back to Wairau Hospital for a general medical review, but the review was refused on the grounds Ruby was examined by a Nelson pediatrician six weeks earlier, and was scheduled to see the pediatrician again in April.
At that visit Ruby was examined under general anaesthesia but the cause of her pain was not found.
The doctors wrote in a submission to the court that Donella appeared "tearful and completely stressed out".
Donella took Ruby back to the emergency department at Wairau Hospital on May 9, and Ruby was admitted.
Staff suspected the pain was from the spinal rod and took a CT scan to send to Wellington.
FEARS FOR RUBY
Staff members were concerned Donella was so stressed she might harm Ruby, Justice Williams said.
They stayed in hospital awaiting the CT results, which came back three days later.
It showed the rod had moved in Ruby's back, but could not prove if that was the source of her pain.
Donella was relieved a physical basis for the pain was identified, but distressed because surgeons said there was no treatment.
She decided to take Ruby home. Ruby was not sleeping well in hospital, and Donella was not convinced there was anything to be gained by staying.
The doctor asked Donella if there was any chance she could do any harm to Ruby, and Donella said 'no'.
The hospital social worker walked Donella and Ruby to the car, and Donella said she was grateful for the scan.
But when the social worker called Donella the next day, Donella took a different tone, Justice Williams said.
"You said, 'you're just one of them, I don't know who to trust. I'm done talking, we are fine thank you', and hung up."
THE LAST STRAW
Three days later, Donella received a letter.
It confirmed there was no obvious reason for Ruby's pain, and said further surgery on Ruby's spinal rod was possible.
"The letter ended with a note of caution," Justice Williams said.
"Surgery will not be easy, and there's got to be a reason to do it."
Donella took that to mean further surgeries were unlikely, Justice Williams said.
"It seems this letter was a trigger for your decision to take Ruby's life. You told the probation officer that when you read the letter, a feeling came over you, that this has to stop."
That was the day Donella killed Ruby.
The court process stretched from May last year to December, with Knox in custody for a time before being released on bail, until her sentencing.
She received four years' imprisonment, the second shortest prison term ever handed down for murder in New Zealand.
Her lawyer Simon Shamy said Donella felt like she had no other option but to kill Ruby, "for Ruby's sake, and her own".
"Most of humanity is not aware of how it feels to be so trapped, so helpless."
"A LIFE LIKE THAT"
The circumstances echo a case heard at the Nelson District Court in 2004, which prompted concern about the amount of support given to families with disabled children.
A father who received permanent name suppression smothered his severely disabled infant daughter, but a jury found him not guilty of murder or manslaughter.
When police found him cradling the girl's body under a bush in a park, he said he didn't really know what he was doing.
"But I looked at her and it wasn't right for a little kid to go through a life like that," he said.
His trial in September 2004 divided the local community.
Disability support workers said the verdict proved society's lesser esteem for the intellectually impaired, and highlighted the need to better assist their families.
Shamy believes Donella needed more support. Not just better medical or respite care, but mental health care as well.
"I've referred to it as a perfect storm because they lived in a small centre with limited medical facilities and not enough money, and no social support. People did their best, but there just weren't enough resources."
Donella's friend Sharna agreed.
"The only reason she's in prison today is because the system failed her. If she'd had enough support, Ruby would still be alive. It hurts me deeply that she's in there."
- The Marlborough Express