Case No. YO21C00174

2021 A was taken by his parents to the A Hospital. This followed an account of a fall suffered by A when he was left momentarily on a changing table by his Father. Initially, A was discharged from hospital with no identified injuries or safeguarding concerns. Upon peer review of the x-rays and a further skeletal survey, A was found to have sustained the following injuries identified by radiography on the following dates:•Chest radiography on 17th April showed the outline, upon review, of the third, fourth and fifth ribs posteriorly, consistent with acute rib fractures. Additionally, there was a potential for a fracture of the seventh rib laterally, consistent with a healing fracture.•A CT chest scan on 20th April confirmed the imaging of the third, fourth and fifth posterior rib fractures.•A skeletal survey on 21st April additionally found a fracture to the left distal femur that was a partly healed metaphyseal fracture, a right distal femur fracture and a right distal tibia fracture.•On 4th May a further skeletal survey additionally identified a right humeral fracture together with the other fractures that had previously been identified.4.It is right to note that twin B was subsequently x-rayed and examined and no injuries were found.5.A suffered 3 accidental events in the weeks prior to the discovery of these injuries. The fact of the events are accepted by all parties, including the Local Authority. The dates of the three identified episodes of falls, that are said by the parents to have caused accidental injuries and explain the injuries discovered, are the 21st March, the 13th April and 17th April 2021. Each event has been the subject of scrutiny during the course of this fact-finding hearing. The mechanism of the falls and the subsequent reaction of A has remained contentious.6.The injuries fall into 2 distinct categories of acute and non-acute. The injuries identified and agreed to be acute are the third, fourth and fifth ribs together with the right humerus and the right distal femur. The non-acute and healing injuries are said to be the seventh, eighth and ninth ribs, together with the left distal femur and right distal tibia. Acute is defined as less than seven days before 17th and 21st April and healing is said to be at least five to ten days before the imaging. 7.The written submissions of the Father contained a helpful summary of the evidence of Dr Barnes consultant radiologist. It is agreed by all parties and I adopt and set it out below:-a.Left 3rd,4th, and 5th ribs – acute on 17th April therefore most likely caused between 7th and 17th April 2021b.Left 7th rib – on or before 12th Aprilc.Left 8 rib – on or before 29th April (this includes dates after safeguarding procedures were invoked in hospital and dates while A was in foster care)d.Left 9th rib - on or before 16th Aprile.Right distal femur – 11th – 21st Aprilf.Right distal tibia – on or before 16th April g.Left distal femur – on or before 16th April h.Right humerus – on or before 29th April. This injury was first apparent on 4th May 2021 therefore Dr Barnes accepted that the most he could say from a radiological perspective was that it was at least 5-10 days old on 4th May 2021. Of course, it may have been present on 21st April but was not seen. 8. Thus, the issue for this finding of fact hearing can be succinctly described follows:- 3 events are described. They are accepted by all parties as having occurred in one form or another, with presentation of A at hospital in the immediate aftermath of the 21st March and the 17th April. Can the LA be disprove the explanations provided by the parents for the injuries sustained by A or not? If the Local Authority cannot so disprove, then it will follow that threshold has not been crossed given that there are no other concerns alleged. If the Local Authority do successfully disprove the accidental explanations, then the court will be left without explanation for multiple fractures to a 6-month-old baby.9.The Local Authority’s case is that the Mother and or Father has inflicted these injuries upon A in at least 2 separate moments of loss of control. The Local Authority contend that the non-perpetrating parent should have known that A was injured as a consequence of his excessive crying and is therefore responsible for failing to protect him.10.Once the injuries were discovered A and B were discharged from hospital on 26th April. They were initially placed together in foster care for a period of one month. On 26th May they both moved to live with the Third and Fourth Respondents where they remain to date. The parents see the children and care for them all day every day under the supervision of the Third and Fourth Respondents. There is currently an interim Supervision Order, the interim Care Order having been discharged and replaced with an interim Supervision Order on 10th August 2021. The family reside in the south of England, but the maternal grandmother resides in north of England and the family was staying with the maternal grandmother when the injuries were discovered, hence the involvement of this Local Authority.11.A brief description of the accidental events are as follows:-12. On the 21st March 2021 the grandfather was holding A in the living room, the family having driven down to visit the paternal grandparents on that date. A somehow wriggled out of his arm and the grandfather attempted to stop A falling but was unable to successfully prevent A banging his head, probably on a nearby coffee table. The PGF attempted to grab A. F was nearby and did grab A as he fell on the coffee table. A was presented to the Hospital very soon after, where the care focused primarily upon his identified head and neck injuries. 13. The second fall was on 13th April 2021 when the Mother was carrying A in the grounds outside the MGM’s apartment and tripped and fell. A fell from his Mother’s arms onto a concrete path. He was immediately taken inside and examined. A decision of all the adults, including 2 visiting friends, was that A had not sustained serious injury and did not require medical treatment. M herself sustained grazed and cut knees.14. On 17th April 2021, A fell from a changing table at the home that the family were sharing with the maternal grandmother. The Father had turned away to get some clothing leaving A on the top of the unit lying on a changing mat. He heard but did not see A fall to the floor. The parents immediately took A to hospital [not the same Hospital as the 21st March given the geography] They disclosed the fall and the visit to the other hospital, but not the fall on the 13thApril, until they were told on the 23rd April that A had sustained multiple fractures.15.To assist the Court in its consideration as to whether these episodes can explain A’s injuries, a series of Part 25 expert medical witnesses were instructed. It is worthy of comment that it has taken a very long time from discovery of injury for the case to reach trial. This was partly as a consequence of Dr Cartlidge [consultant paediatrician] advising that it was necessary to instruct a Clinical Geneticist. In the end, two Geneticists were instructed, namely Dr Irving and Dr Saggar, as was a Consultant Paediatric Radiologist, Dr Barnes. Additionally, the Court heard from the Consultant Paediatrician who was on duty at the second Hospital at the relevant time, namely Dr D.16.The Local Authority threshold is that the injuries sustained by A were inflicted as a consequence of a loss of control by one of his parents. Additionally, that the parent who inflicted the injury did so by exerting pressure or otherwise assaulting A in a manner that they would have realised was excessive and inappropriate. The non-perpetrating parent should have been aware that the injuries had occurred by reason of the child’s reaction to normal handling after infliction of the injuries and should have sought medical assistance sooner than 17th April. It follows that on the Local Authority’s case both A and B are at risk of suffering significant harm from similar inflicted injury if returned to the care of their parents. 17.The parents’ case is that they have been loving, caring parents who did everything they could to care for their twins to a high standard. They accept that it is extremely unfortunate and somewhat embarrassing that A was subjected to three accidental episodes in such a short space of time. They attended upon the hospital following the episodes on 21st March and 17th April. They did not attend at the hospital on 13th April because they did not believe that A had sustained injuries that required medical assessment or treatment. Further, that they did not disclose on 17th April that A had had a fall on 13th April because again they did not believe this to be of significance. They later disclosed this episode a few days later upon being told of the extent of the multiple fractures that A had been found to have sustained following additional radiology. The Local Authority regard the late disclosure of the event on the 13th April as having a more sinister explanation.