A Madison woman was charged with felony physical abuse of a child and felony first-degree reckless injury at her initial court appearance Thursday.

Debra Koenig, 44, was providing daycare for a 2-year-old Verona girl on the morning of January 22. According to court documents, Koenig said she became "the most frustrated she has ever felt in her life" when the child vomited several times while in her care. Koenig said she "snapped" after the child vomited on her, and she pushed the child hard into a wooden stool.

After the child hit the stool, she lay draped over it for up to a minute. For the next several hours, Koenig did not seek medical attention despite the child being unresponsive and looking "corpse-like."

As a result of the push, the child suffered a torn pancreas and severed intestine, which caused digestive fluid to leak into her abdomen and damage other organs.

"My client didn't realize the nature and the extent of the injuries — the child didn't cry or anything like that," Koenig's attorney, David Mandell, said. "The child was already sick; she just thought the child was sick."

But according to doctors who treated the child at Meriter Hospital and the University of Wisconsin Hospital, due to the severity of the injuries it would have been "immediately apparent (or very shortly thereafter)" that the child needed emergency medical attention.

The trauma the child experienced was similar to trauma sustained by children involved in high-speed collisions while wearing seatbelts — the seatbelt puts pressure on the abdomen, forcing the organs to push against the spine and sever.

The 2-year-old underwent several surgeries, and at times it was unclear whether she would survive. It was not until after the child was stable that Koenig told police about the fall she sustained while in her care.

"This was an accident — it was very unfortunate," Mandell said. "Anyone would be kind of scared not knowing what was going to happen and what people would think."

Before Koenig came forward, hospital officials questioned the child's parents about the injuries.

Ami Orlin, child protection services manager for the Dane County Department of Human Services, said the law requires any hospital worker who suspects a child might have been abused or neglected to report their suspicions to the Department of Human Services or to local law enforcement.

"There's things we know about injuries to children that are indications of abuse," Orlin said. "It would not be normal, for example, for a toddler to have bruises around their neck or in the middle of their back."

Orlin said officials also use the child's medical history as an indicator — if the child has had a series of unexplained injuries, for example, that might mean there are abuse issues at home.

Ultimately, Mandell stressed that criminal complaints written by police are often unfair to the defendant.

"They take things out of context, and whatever they can use to make their case look good, that's what ends up being used," Mandell said.

The child was finally taken to the hospital after her mother picked her up from Koenig's home after work, at about 9 p.m. The mother said in court documents that she saw her daughter lying limp on the defendant's couch. The mother asked if the child was dead, to which the defendant replied, "Not yet."

According to Assistant District Attorney Mike Verveer, who was in court Thursday with Koenig, the defendant appeared voluntarily in court after refusing signature bond.