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Susan Elizabeth MacDonnell pleaded guilty to aggravated assault and failing to provide the necessities of life in November 2011. (CBC)

A sentencing hearing began Monday morning in Nova Scotia Supreme Court for a Dartmouth woman who starved a foster girl in her care.

Susan Elizabeth MacDonnell, who pleaded guilty to aggravated assault and failing to provide the necessities of life in November 2011, sat beside her husband in court on Monday and quietly sobbed and dabbed her eyes.

The victim, who was 22 months old at the time, was living with MacDonnell in February 2010 when she was hospitalized at the IWK Health Centre for dehydration and malnutrition.

Staff at the IWK Health Centre then suspected further abuse when the toddler was slow to recover while hospitalized.

The Crown said the girl nearly died because she was deprived of food for some time.

"What she did was she created the situation and starved the child almost to death in an attempt to get attention on her as a wonderful mother, a loving mother who was staying loyal to her child throughout a very, very difficult medical time," said Catherine Cogswell, Crown prosecutor.

At an earlier bail hearing, MacDonnell admitted to disconnecting the child's feeding tube in the hospital and to diluting a high glucose formula at least six times.

MacDonnell's sentencing hearing was originally scheduled to take place last May, but was delayed when Nova Scotia Supreme Court Justice Kevin Coady ordered another psychiatric assessment for the accused.

Remorse questioned

Dr. Grainne Neilson, the forensic psychiatrist who examined MacDonnell, told the court Monday that MacDonnell is a "perpetrator of child abuse" suffering from "factitious disorder by proxy."

"Her own behaviour and her own understanding has not developed at all beyond the words," Neilson said.

Neilson testified MacDonnell committed the abuse to meet her own psychological needs. She questioned MacDonnell's remorse, saying the former foster mother claims not to remember the incident.

"How can she feel guilty about things that she can't even remember?" Neilson said, calling MacDonnell a public safety risk.

MacDonnell's lawyer disputed that position, saying her client had made good progress with a psychologist.

Neilson rated MacDonnell as a low to moderate risk to reoffend.

The Crown said that rating needs to be put into perspective:

"A low-moderate risk as compared to other violent offenders in prison, not low-moderate risk as compared to the public generally. The risk would be astronomically high compared to just the general population," said Cogswell.

The Crown is asking for a five-year-sentence, while the defence has requested two years plus probation.

The girl, now four years old, has been adopted by another family. Other foster children in MacDonnell's household have since been removed by the provincial Department of Community Services.