“Intent is a broad concept,” he said. “What it takes to cause injuries to these children is less than what it takes to cause injuries to you and I.”

But he acknowledged that what his client did was “intentional because he did it on purpose.”

Karofsky later called Moeser and Bednarek into her chambers after Bednarek and Kaphaem resisted the judge’s attempt to get Kaphaem to explain in his own words what he had done to the victim in the first count in the criminal complaint.

Bednarek said there was some confusion about which child in the complaint was which, and Kaphaem told her “it’s difficult for me to remember each infant that I cared for.”

After about a seven-minute recess, the hearing continued. Karofsky did not again ask Kaphaem to explain what he had done in each of the 18 other counts.

Meriter received an “immediate jeopardy” citation, the most serious kind, in March 2018 after a federal inspection found it didn’t respond appropriately when an infant was discovered bruised in April 2017. An inspection in June 2018 found the hospital to be in compliance with Medicare rules.