Trial highlights clash between parental rights and medical advice

4-month-old Caleb Tribble, the day before he died. Now his parents face jail. Picture / Paul Estcourt

On the last morning of his life, Caleb Tribble giggled as his dad David tickled him. The 4-month-old baby had been sick for a fortnight with what seemed like a tummy bug, but on Friday December 5, 2003, Cathy and David Tribble were pleased to see him smiling again, if a little tired and pale.

After a visit from the public health nurse, who weighed and measured Caleb and told his mum to fatten him up as fast as she could, Cathy tucked him into bed for a morning nap. Caleb put his thumb in his mouth, closed his eyes, and died.

The story might have ended there, but later that night a tearful and weary David Tribble told a police officer that he had become worried about Caleb's symptoms, including diarrhoea, vomiting and weight loss several days earlier.

"I became quite concerned about him because I didn't like the look he had in his eyes," said David Tribble, a stocky, bearded man of 43 in a bare interview room at Whangarei Police Station.

"He looked quite sick. I said to Dad that he had a spirit of death on him. He had darkened eyes; I believed it was a spiritual thing. Almost demonic, a demonic spirit that's there, it can kill you; a curse, a curse on him or something. It blew me away because I've nearly died many times and I had to speak to somebody about it. I went down to Dad and spoke to him about it.

"We had a long talk about it and we thought we'd have a prayer for the child, he broke that [the curse] off him. Which Dad has some experience in, demonic deliveries."

Those remarks started a chain of events which ended this week in the High Court at Whangarei, where David and his wife Cathy Tribble, 36, faced a criminal trial. Yesterday, after 12 hours of deliberations, a jury found them not guilty of manslaughter but guilty on an alternative count of failing to provide the necessities of life - that is, medical treatment.

The questions in this trial went far beyond the details of Caleb's death. The trial became, as well as a test of the evidence, a test of faith. Is it reasonable to turn to God for healing? If a parent has a premonition of his child's death, what should he do?

Is someone who admits to praying for their children an irresponsible parent? Or in modern New Zealand, is it dangerous to talk about God, especially to a policeman?

Nobody knew what was really wrong with Caleb until a post-mortem examination. He died of blood poisoning, brought on by a kidney problem known as vesicoureteral reflux (VUR), in which urine sometimes flows up from the bladder back into the kidneys, causing infection. The infection would have been difficult to detect without blood and urine tests - but could have been easily treated in a hospital up till December 4, paediatrician Dr Peter Jankowitz told the court.

So there was another issue here: the advice of health professionals.

The centre of the Crown's case was evidence from the public health nurse (whose name is suppressed) that she had tried to urge the Tribbles to seek medical help because his apparent bug was lingering.

She visited the baby several times, including on the day of his death, and expressed concern about his condition, but never told them Caleb might die, or ordered them to go to a hospital. Three other paediatricians she consulted also never rang the police or demanded the Tribbles go to hospital.

"No one said 'Look, this boy will die'," said counsel for Cathy Tribble, Arthur Fairley. "If the medical world had said that, and these people said 'get lost', they'd be guilty. But it wasn't said, because nobody knew until it was too late," he told the jury.

The Crown case was that the Tribbles, who describe themselves simply as Christians, had relied on prayer to heal Caleb. Prosecutor Kim Thomas said the Tribbles rejected the advice of the public health nurse to take him to a doctor because they wanted "so desperately to believe" that God could cure Caleb.

"They relied on prayer first and they're entitled to do that, but given the extent of his illness, that was a serious failing," Thomas said.

The Tribbles always admitted they prayed for Caleb, the eighth of their nine children, but said they always sought medical advice and would have taken Caleb to a doctor if they had not believed he had caught the same bug their other children had suffered briefly from that month.

Cathy Tribble said although she believed God could heal sick people, she had taken many of her children to doctors for antibiotics, injections and surgical procedures.

"If I had known what Caleb's condition was, I would have taken him to hospital myself," she said during cross-examination. "As a Christian, I would have prayed before I took him to a doctor, but we only thought he had a tummy bug."

David Tribble told how he had become a believer in God's healing power after having six years of treatment for testicular cancer, including surgery and chemotherapy, as a young man. While he was sick, David said his father John and other friends prayed for his recovery.

"I chose medical treatment. It wasn't entirely successful with the chemotherapy, I also required surgery, [and] I was prayed for as well to assist with the medical treatment."

Asked what he would have done if he knew Caleb was so sick, he said "I would have rushed him to the doctor, the hospital". The public health nurse said she believed David Tribble seemed suspicious of her visits, but both parents denied this.

For three weeks, Cathy and David Tribble sat at the back of the court, she wearing a demure headscarf, he in work-shirts with the sleeves rolled up. Sometimes they held hands.

Neighbours, Correspondence School teachers and friends queued to tell the court they were loving, responsible parents who lived a quiet, self-sufficient country life and adored one another.

But on the second day of evidence, the jury of seven women and five men returned from an adjournment with a question for the judge: can we convict one spouse and not the other? Just listen to the evidence, Justice Geoffrey Venning said. There will be plenty of time for decisions later.

David and Cathy Tribble live in a three-bedroom rented house near the tiny settlement of Pakotai, about 40 minutes' drive northeast of Whangarei. They married in 1993 and had their first baby the following year. At first, they shared the house with David's parents, John and Alice.

John Tribble, a former Army engineer and forestry worker, said he became a Christian 30 years ago and discovered he seemed to be able to heal ailments from emphysema to limps through prayer. "I've got a strong faith in my God but I don't push it on anybody else," says John Tribble, 68, a man with an impressive white beard. "I've prayed for heaps of people, anyone who asks me for help. If we hadn't prayed for Caleb, none of this would have made the headlines," he said.

"We don't have a problem with doctors. I took [his wife] Alice to the doctor last Tuesday because she had the flu, and he gave her some antibiotics. I took [David and Cathy's 11-month-old baby] in at the same time, she was due for her check-up," John Tribble said.

Every detail of the Tribbles' medical history was probed by the Crown, including Cathy's decision to begin having natural labours after her first two children were born by caesarean in Whangarei Base Hospital. In cross-examination, Cathy Tribble admitted an obstetrician had warned her vaginal labour might be life-threatening, but denied that this was in any way reckless.

The Tribbles do not immunise the children but said they were sceptical about the medical need to do so, rather than any religious objection.

Cathy Tribble said she had a tendency to "panic" with her first children over minor problems, describing how she rushed one daughter to hospital with symptoms including lethargy, fever and a rash.

"It turned out she was teething and had heat rash. The doctor gave me some [pain reliever] Pamol and told me to go home," she said.

It was Cathy Tribble who raised the first concern about Caleb. On November 4, 2003, she rang the district public health nurse, who came to the house, weighed the baby at 6.01kg and reassured Cathy that he had a high birthweight of nearly 5kg, so slow weight gain was not a problem.

"Lovely young man, meeting all milestones," the nurse wrote in her official practice notes. By November 26, she noted Caleb's weight gain had slowed further and Cathy reported he had in the previous few days had a temperature, lethargy and diarrhoea. The nurse noted "all the signs are good", Caleb did not seem dehydrated and that Cathy was to keep his fluids up.

On Monday December 1, David raised his concerns about the "spirit of death" and suggested they might need to take Caleb to the doctor, he said in evidence.
They prayed for the baby with John and Alice Tribble, and during that week David and Cathy thought they began to notice signs of recovery.

A week later, on December 3, the nurse returned for her regular Wednesday visit to find Caleb's weight had dropped to 5.4kg, although he did not seem dehydrated. "I told mum I was very concerned about Caleb's welfare and that he required medical attention. She was not so keen, she felt that Caleb was picking up, she wanted to wait and see," the nurse's notes said.

Two paediatricians consulted by the nurse suggested Caleb should come in for monitoring, but the nurse said she rang the Tribble house three times that evening and was reassured by David that Caleb had was having hefty nine-minute breastfeeds and seemed much better.

David Tribble insisted in evidence they told the nurse they would rather come to hospital the following morning. In her evidence, the nurse said this was just "some vague comment" by David, which she did not necessarily believe. She called again at 9am the following day, December 4, and noted that Cathy Tribble sounded "bubbly" and said Caleb was feeding well.

But when the nurse returned to the Tribble house about 10.30am on Friday December 5, she was shocked at his thin, weak state. In her notes she said Caleb had again lost weight. By noon that day, Caleb was dead.

Cathy Tribble's memory of that visit was that when the nurse walked into the house, "she said 'He's looking a lot better, Cathy'. His weight loss was disappointing to us both but she checked him and said otherwise he looked not too bad," Cathy Tribble told the jury.

IN court, the public health nurse told a much more dramatic version of that December 5 visit. She said she had been "absolutely blown away" by Caleb's sunken eyes and "floppy, dehydrated" body, and felt the Tribbles had misled her about his condition. "I was in shock and I felt that all trust was gone," the nurse said during three days of evidence, during which she frequently sobbed.

"I was thinking about ringing CYFS and the police."

But she admitted she never indicated this level of concern to the parents on the Friday morning. She said she never told the Tribbles the baby might die, or insisted they take him to hospital, because she was worried about the reaction.

Asked if she had panicked, the nurse said: "Who wouldn't panic in that situation? I felt unsafe in the whole situation; it was surreal."

In his closing statement, defence counsel Ron Mansfield suggested the nurse might now be trying to conceal the fact she had not noticed Caleb's serious condition. "Corporates" such as the district health board which employed the nurse were very quick to deny responsibility, Mansfield said. "They got it wrong, [the] nurse got it wrong, the paediatricians [consulted by the nurse] got it wrong; they were all fooled. They all thought this was a gastro illness and it would be addressed by feeding."

Cathy said after the nurse left on December 3, she put Caleb down for a sleep, and returned shortly later to find him dead. David tried to revive him with CPR but knew he was already gone. A neighbour, Patricia Nairn, arrived to find the entire family sobbing around the "blue" body of Caleb. "They were praying to God to bring Caleb back alive, or to resurrect him, I guess," Nairn said.

Caleb's urinary tract, bladder and kidneys were full of pus, said the forensic pathologist who conducted his autopsy, Dr Tim Koelmeyer. "I think this boy required surgery to fix this. I haven't seen anything quite so bad, ever." He said the condition could cause renal dwarfism if untreated.

Faith was everywhere outside the court in the three weeks the Tribbles were on trial. Just down the hill, wooden signs invite passing motorists to faith-healing sessions. Five churches are within walking distance.  Mormons wander down Bank St in search of lost souls. At the World of Fitness gym, TVs blare American televangelists commanding invalids to arise.

But faith had no relevance in a criminal trial, said Mansfield. "This is not a case of [choosing] prayer over medicine. There is nothing unusual or slightly suss, or illegal or criminal in having a strong faith and being involved in prayer. What's wrong with seeking medical advice and also praying? Absolutely nothing."

There was no question that the couple loved their children, as prosecutor Kim Thomas told the jury.

"This is not a case about neglect. It's not an issue about [the Tribbles] being cavalier and not caring less. They may care for their children deeply, they may have their own way of dealing with the world - such as a tendency to leave it to God to heal Caleb. That may have led them, quite innocently from their perspective, to take something of a rose-tinted view as to what the condition of Caleb was. That view of the world may explain why, in this circumstance, good parents failed to act."