Heard on 15.7.24 -28.8.24 |
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B e f o r e :
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London Borough of Croydon |
Applicant |
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- and - |
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Mr and Mrs D |
1st/ 2nd Respondents |
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A, H and Y through their Children's guardian |
3rd/4th/5th Respondents |
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Re: LB Croydon v D (critical scrutiny of the paedeatric overview) |
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For the LA : Giles Bain leading Lily Cooke
For the Mother: Professor Delahunty KC leading Emily James
For the Father: Brendan Roche KC leading Alison Easton
For the Guardian: Alison Moore leading Kate Claxton
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Crown Copyright ©
Introduction
Background incorporating the schedule of agreed facts
a. The mother presented late for antenatal care at 26 weeks on 24.11.2022, following a fall in the shower on 15.11.2022 when she attended A&E and foetal movements were felt;
b. A's birth on 02.03.2022 was traumatic, requiring repeated attempts at emergency anaesthesia by epidural and C-section.
c. The mother suffered with, and was treated for dizziness, during her pregnancy with A and after his birth, including by attempted blood transfusion.
d. The mother breast fed A for two months after his birth and became pregnant with the twins whilst breastfeeding.
e. An ultrasound on 21.09.2022 described a high-risk twin pregnancy of 20+4.
f. The mother was admitted to Croydon University Hospital as an emergency on 19.10.22 due to Preterm Premature Rupture of Membrane (H) and was transferred to St George's Hospital for specialist neonatal care.
g. The mother remained at St George's Hospital until 02.11.2022, during which time she could not care for A who was 7 months old at the time.
h. Due to missing A and the responsibility she felt to resume care of him she discharged against medical advice on 02.11.2022. This was a joint decision by the parents.
i. The mother went into labour with the twins and was transported by ambulance to hospital on 20.11.2022.
j. The twins were born at 29+2 by emergency C-section, D at 02.25am and Y at 02.30am on 21.11.2022.
a. The state of the family accommodation, which was cold and damp, had mould on the walls in each room including the kitchen, bedroom and living room, no heating which therefore required an expensive electric heater to be used and at times and no hot water.
b. The parents were very concerned about the impact upon the twins' health of this environment in light of their prematurity and their breathing difficulties at birth.
c. The parents' relationship with their landlord deteriorated which added additional stress and the parents felt he was not supporting them in addressing the problems in their accommodation. The parents did not pay rent for January 2023, and they received an S21 eviction notice prior to 10.02.2023.
a. The father was unwell/had rheumatism on or about 16.01.2023 to the 21.01.2023
b. H had constipation and experienced difficulties with her breathing which resulted in an ambulance being called and her attending A&E on 01.02.2023
c. H was unwell with a likely viral illness on 13.02.2023
d. Father became unwell with flu/Covid symptoms from 5-18.03.2023 and contact was made with the London ambulance on six occasions between 08 and 11.03.2023 for assistance;
e. A became unwell with flu/covid symptoms and was diagnosed with Covid on 11.03.2023
f. The mother was unwell with flu/Covid symptoms and was diagnosed with Covid on 11.03.2023
g. H was unwell with flu/covid symptoms from 13.03.2023 and was diagnosed with Covid on 18.03.2023;
h. Y was unwell and was diagnosed with Covid on 18.03.2023.
The 18th March 2023
The Law – Burden of proof
The law – evidence
Child H
i.) A buckle fracture of the right shoulder blade.
ii.) Eleven rib fractures: 5th – 9th left ribs close to the spine and 5th – 8th right ribs close to the spine and 3rd -6th Left rib toward the side.
iii.) A fracture of the metaphysis (the part of the long bone that joins the shaft to the knuckle) at the lower end of the left shin bone.
The fractures were no more than about 2 weeks old on 21.03.2023.
Child Y
Child A
The issue for determination
The parents account – child H
59. When H woke Mrs D, immediately, identified that her cry sounded different and her chest was moving in a different way. Mr D says this in his witness statement dated the 01.02.2023 "When my wife brought H into my room on 18 March, H's face and lips were darker, and she was breathing badly. We followed the advice that we had been given by the nurse at the hospital. My wife and I first did chest compressions on the middle of H's chest. I think we did these 4 or 5 times in total, maybe me twice and my wife three times. I blew in H's mouth. When H's breathing did not get better I told my wife to pick H up and shake her hard …. This is what we had been advised to do by the nurse at the hospital if the chest compressions did not work".
The parents account – Child Y
The Mother
The Father
81. He was pleasant enough in his description of Mrs D being "devout… raised properly…disciplined…..good manners…. Rock solid lady" but it was sadly devoid of any real sense of emotion or love.
The Health Visitor
The Clinicians - medical professionals at the hospital
Dr Keenan
Dr Nicola Cleghorn and the seminal role of the expert paediatrician
- to provide a concise medical chronology taken from the volume of available clinical medical data.
- to clearly signpost the court to the relevant data.
- to properly evaluate the evidence as to whether an injury was inflicted or not.
- not to be speculative.
- to correct errors in their own work and identify errors in the work of others.
- to limit opinion evidence to their individual specialty.
- to revisit past conclusion in the light of fresh evidence.
- and not to remove evidence of relevance from the judge's determination.
Dr Olsen -the radiologist
Lack of evidence around Metabolic bone disease of prematurity (MBDP)
Discussion
Injuries to H
Injuries to Y
139. The LA say that even if this occurred it was not within the window of the 7-21.03.2023. They point to the Health Visitor record of the 10.02.2023 as evidence that the basinets were not in use after that date. That they say categorically places the event outside the timeline identified by Dr Olsen and therefore cannot account for Y's injuries. However, that account reads as follows: "the second bedroom where there was lot of clutter stored such as Moses basket stands, dismantled cot and clothes…..it was reported that the Little Village Charity brought a cot yesterday which Mr D will put together, however, he requires a mattress for it. This will then allow A to have his own cot and Y and H can share one. All of this speaks to future intent. Further the Health visitor record of the 03.03.2023 refers to Y being "asleep in her crib". I am not satisfied on the balance of probability that as a matter of fact the basinets were not used from the 10.02.2023.
'Bruises' to both H and Y