A man accused of murdering his daughter by recklessly withholding her diabetes medication was repeatedly told by medical professionals she needed insulin to survive.
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Eight-year-old Elizabeth Struhs died at the family home in Toowoomba, west of Brisbane, on January 7, 2022, after her parents and 12 others allegedly withheld her medication for six days in favour of prayer.
Brendan Luke Stevens, the 62-year-old leader of a Christian group calling itself The Saints, is on trial for murder along with the girl's father, Jason Richard Struhs, 52, in the Brisbane Supreme Court.
Elizabeth's mother, Kerrie Elizabeth Struhs, 49, and the other 11 members of the congregation are charged with manslaughter.
Queensland Children's Hospital diabetes unit nursing manager, Karen Bragg, testified on Tuesday during the judge-only trial's fifth day before Justice Martin Burns.
Ms Bragg said Jason Struhs was given multiple training sessions about monitoring Elizabeth's glucose levels and administering medication after she was hospitalised with extreme diabetic shock in 2019.
"It was about looking after a child with Type 1 diabetes, what Elizabeth will need to survive and her need to be on insulin for life," Ms Bragg said.
She identified several items used to test glucose and administer insulin along with a diabetes management diary filled out with Elizabeth's blood results and carbohydrate intake that police found in the Struhs' home in January 2022.
Ms Bragg and senior dietician Michelle Fuery both testified that Kerrie Struhs did not take part in the training.
Queensland Children's Hospital senior endocrinologist Louise Conwell said Elizabeth was "minutes from death" when her father carried her into a Toowoomba emergency department in July 2019.
Professor Conwell said Elizabeth was flown by helicopter to the hospital in Brisbane after her then-undiagnosed Type 1 diabetes left her relying on adrenaline doses and a ventilation tube to keep her heart and lungs working.
"It was extremely rare ... she was the most seriously unwell child I have ever seen," Prof Conwell said.
Under questioning from crown prosecutor Caroline Marco, Prof Conwell said she explained diabetes to Jason and Kerrie Struhs and that lifelong medication would be necessary to keep Elizabeth alive.
"I explained she was near to death at that time and was still critically ill ... she would require ongoing insulin treatment," the specialist said.
All 14 defendants are self-represented and have refused to enter pleas with Stevens telling the court they had reasonable belief that God would cure Elizabeth's diabetes.
Camellia Claire Stevens, 28, one of the 11 charged with manslaughter, cross-examined Prof Conwell and asked if Elizabeth's recovery in 2019 had been "quite miraculous".
"It was very fortunate. She had excellent treatment from the moment she was taken to Toowoomba hospital. It is a testament to her prompt treatment and continued care ... without that treatment she would have died. She was minutes from death," Prof Conwell said.
Jason Struhs told police he took Elizabeth to hospital against the wishes of Kerri Struhs, who would later be imprisoned for five months for failing to provide Elizabeth with the necessities of life in 2019.
Kerrie Struhs told Detective Sergeant Andrew Lowe "God can work the seemingly impossible".
"I believe thoroughly that God is in our life. He has promised healing," Mrs Struhs said in a police interview played to Justice Burns.
When asked what treatment she provided Elizabeth as her undiagnosed diabetes worsened, Kerrie Struhs said she gave her nappies to wear at school.
Prof Conwell earlier testified that Elizabeth suffered incontinence as her body tried to rid itself of excess sugar.
The other defendants are Loretta Mary Stevens, 67, Andrea Louise Stevens, 34, Acacia Naree Stevens, 31,Therese Maria Stevens, 37 Keita Courtney Martin, 22, Lachlan Stuart Schoenfisch, 34, Samantha Emily Crouch, 26, Zachary Alan Struhs, 21, Sebastian James Stevens, 23, and Alexander Francis Stevens, 26.
Australian Associated Press
