England and Wales Family Court Decisions (other Judges)

THE FAMILY COURT SITTING AT READING

		2ND DECEMBER 2015 TO 4TH DECEMBER 2015

Introduction

I am dealing with a fact-finding hearing to determine the causation and perpetration of a skull fracture LT, aged 14 months, was found to have suffered when she was taken to hospital by her mother and maternal great grandmother on 22^nd July 2015. Her mother is CT and her father is NT. Mr and Mrs G are the family friends currently caring for LT under a child arrangements order.

I have read all of the evidence in this case contained in the Bundle and have heard from various witnesses over the course of this hearing.

Background

The Local Authority became involved with this family on 7^th July 2015 when a single assessment was carried out following an incident of domestic abuse on 3rd July 2015, as a result of which CT had been injured. During the assessment the social worker's view was that the parents were minimising the issues of domestic abuse between them. However, they were no longer living together, CT was informed about the Freedom Programme and the case was closed.

The precipitating event for the further involvement of the Local Authority occurred on 22 July 2015. LT was taken to St Mark's walk-in Medical Centre that morning after CT stated that she had noticed a large boggy swelling on LT's head which she reported was not there the previous evening. Subsequent investigations revealed that LT had sustained a left parietal skull fracture and a full skeletal survey also at this point concluded that there were healing rib fractures. Subsequently the Consultant Radiologist instructed in this case, Dr Karl Johnson, has confirmed that these were not in fact healing rib fractures and this opinion is accepted by the hospital radiologist, Dr Latif, so the only alleged injury that I am dealing with is the skull fracture.

LT had been with her father on 21 July 2015 from around 12.30pm to around 3.30pm. Thereafter she had been at home with her Mother and her maternal great grandmother, HP.

It was noted during the hospital examinations that initially CT was unable to provide an account for the injuries. However, after further enquiry, she stated that LT had fallen the previous day at home when crawling between the kitchen and conservatory.

CT's first statement dated 17 August 2015 (C23-27) described two incidents that she alleged had taken place on 21 July 2015 when LT fell on the floor in the conservatory and later against the wall in the bedroom. She repeated this in her second statement dated 23^rd November 2015 (C52-C55).

The Local Authority commenced proceedings on 12 August 2015 and there were case management hearings on 13 August 2015 (B43) and 20 August 2015 (B48). The matter was listed for this fact-finding hearing on 2^nd-4th December, leave was given to instruct a radiologist and medical and police disclosure was ordered. Dr Karl Johnson, Consultant Radiologist, was also instructed as I noted earlier.

LT was placed with family friends, Mr and Mrs G initially pursuant to s.20 CA 1989 but following a hearing on 11^th November 2015 a child arrangements order was granted to them to enable LT to remain in their care.

Parties' positions

The Local Authority seeks findings in this case as follows:

1. LT sustained a left vertical parietal skull fracture with overlying soft tissue swelling.

2. The fracture was sustained by LT between 8^th and 22^nd July 2015 and probably on the morning of 22^nd July 2015 when LT was in the sole care of her Mother.

3. The fracture was not caused by a medical condition.

4. The fracture was caused by a fall, blow or impact to the side of the head.

5. The amount of force required to cause the fracture is significantly greater than that used in the normal care and handling of a baby.

6. At the time the fracture occurred LT would have been in pain and showing signs of distress.

7. The mother's explanations for the fracture are implausible and do not account for the fracture. In particular:

(i) LT's fall in the conservatory from crawling height on 21^st July 2015 did not cause the fracture;

(ii) LT's alleged fall on the bed on 21^st July 2015:

(a) did not happen at all; or

(b) did not happen in the manner alleged by the Mother;

(c) in any event did not cause the injury.

8. The cause of the fracture is unexplained.

9. The Mother would have known that the force used to cause the fracture was excessive and was likely to result in an injury and that LT was distressed as a result of the injury.

10. The Mother failed to provide the medical professionals with a truthful account of what had occurred and by doing so prioritised her own needs over and above LT's.

CT accepts that LT suffered a skull fracture. She says that she discovered a "soggy" lump on the left side of LT's head at around 7am on 22^nd July 2015. She says that she showed this lump to the maternal great grandmother and that she attempted to text and ring her mother about the lump. She describes LT as exhibiting no distress when the lump is touched. The maternal great grandmother was of the opinion that they should take LT to the walk-in clinic that day to be on the safe side and so they took LT there at around 10am. CT also accepts that she did not initially mention to any professionals or her family that LT had had a fall on the bed on 21^st July 2015. She denies causing LT any injury herself and puts forward no other possible explanation for the injury beyond those explanations already offered by her.

In respect of NT, no findings are sought against him.

The Guardian has succinctly summarised the issues in this case as follows:

1. "There is no dispute that LT suffered a left parietal skull fracture discovered on X Ray on 23/7/15. There is no dispute that this must have been a significant event given the extent of the injury. There is no dispute that given her age it is extremely unlikely that this event would have occurred out of the sight of an adult without them being aware of it subsequently, because of her reaction to it. LT's mother has proffered two substantive explanations. The second is deemed by Dr Johnson to be a plausible explanation of the injury. The issue for the court therefore, it is submitted, is two fold;

i) Did the event as described by mother occur at all and if it did;

ii) Was it likely on balance of probability to have caused the injury;

iii) Does the timing fit with the injury as observed at Hospital on 23^rd July 2015

2. It is submitted that if, on the balance of probabilities, the court finds mother's evidence credible on this issue and the evidence of Dr Alexopolou on the progression of the swelling places the injury within a window of possibility, then the court cannot find that the injury was caused non accidentally or through want of supervision.

3. If the court does not find mothers evidence on the issue of the "bed" incident plausible then it is submitted that the injury is "unexplained". Given LT's age and her likely reaction to an incident causing such a major injury it is implausible for the parents not to have remembered such an incident, particularly given Dr Johnsons evidence on causation. In those circumstances it is submitted that the court would be drawn to a conclusion that the injury has only two possible explanations it was either inflicted by an adult or the result of LT falling some distance onto a hard surface. If the latter explanation is true the court would need to consider why neither parent has proffered this as an explanation, as they would have known about it. It is submitted, subject to how the evidence plays out, if the court rejects mother's evidence, it is unable to make a definitive finding as to how the injury was caused or by whom."

Medical and Expert evidence

As I have earlier noted, the Consultant Radiologist in this case is Dr Johnson. His expert report dated 30^th October 2015 starts at E9 of the Bundle. He confirms the presence of the skull fracture and estimates that the fracture is no older than a couple of weeks as at 22nd July 2015. He has considered the explanations given by CT and concludes that LT falling on the conservatory floor would not account for the injury, but LT standing up and then falling against a wall could potentially cause this fracture depending on the force applied to the skull at the time of the impact. He therefore does not exclude it as a possible cause, but has not stated that this incident was more likely than not to have caused the injury. He was called in this case as a witness via videolink specifically to hear CT give her evidence about the alleged fall on the bed on 21^st July 2015. As a result of that, he reiterated his earlier opinion that a fall against a wall could provide both a suitable mechanism and sufficient force to cause the fracture. He posited three scenarios based on CT's evidence. First was that LT fell against the wall from a standing position. Second was that LT fell onto her bottom first and then separately from a sitting position fell against the wall, ie two separate or staged falls. Third was a fall where LT fell onto her bottom and then immediately against the wall as one fall. He was unable to quantify how likely each was as a potential cause, beyond saying that a fall from standing on the bed would be the most likely scenario to have caused the fracture, and a staged fall (ie where LT fell in two distinct stages) was less likely but he could not exclude it as a possible cause.

Dr Alexopolou, Consultant Paediatrician, saw LT at the hospital on 22^nd July 2015. She has provided a statement dated 19^th November 2015 (C56-59) and her contemporaneous medical notes are also contained in the medical disclosure at section H of the Bundle. She was also asked by the Local Authority via email if she could provide an answer to the question "in your view when is the injury likely to have occurred?" Her response, dated 1^st December 2015, was to the effect that it was very difficult to give a specific response to this question as it is very difficult to date fractures but that a soft tissue swelling associated with a skull fracture is an indication of an acute injury...As I mentioned in my statement the swelling might not be present immediately and it can present at a later stage. This is my professional opinion as the treating clinician and not as an expert witness". She also gave evidence to me in course of this hearing in which she confirmed that it was not possible to accurately indicate when the injury was likely to have occurred. Whilst she said that the swelling on 22^nd July 2015 made it potentially more likely than not that the injury happened at another time than the fall on the bed at around 7pm, she could not say that it didn't happen at that time either. She was also very clear that she was providing me with her professional opinion as a clinician and based on her own experience rather than providing evidence in an expert witness capacity.

I have also been assisted by the medical records in this case contained in section H of the Bundle.

Other professional evidence

In relation to the issues for this fact-finding hearing, evidence given in the course of the parenting assessment (dated 26^th November 2015 at C60-107 of the Bundle) was also adduced and Liann Noble, the assessor, was called to give evidence. At C82 Ms Noble recorded what CT told her on 2^nd October 2015 about the fall on the bed. This was said by her to be a spontaneous and verbatim record as follows: "CT stated that later that night she gave LT a bath, and she wouldn't settle, she was crying and we were sitting on my bed and she was holding onto my shirt and wouldn't let go. She finally let go and fell back onto her giraffe and then hit the wall". CT does not accept that she said the words "wouldn't let go" in relation to that incident but said them when describing how LT wouldn't let go of her at the hospital. Ms Noble confirmed that it was her recollection that those words were used in describing the incident involving the fall on the bed.

Police disclosure is also contained in section J of the Bundle, including the witness statements taken in the course of the Police investigation.

Parties' evidence

CT gave me evidence to confirm the contents of her two statements but with one amendment to her first statement to record that she was lying on the bed with LT when LT allegedly fell against the wall. She said that she did not remember much of what happened at hospital on 22^nd July 2015, but accepted that she had not disclosed the fall against the wall or in fact any possible trauma when asked by various professionals. She told me that she did not disclose the explanations given later because she felt scared.

NT did not give any evidence in the course of this hearing because no findings are sought against him of any kind.

Relevant legal considerations

I have had regard to the guidance of Baker J in Re IB and EB [2014] EWHC 369:

"81. The law to be applied in care proceedings concerning allegations of child abuse is well-established.

82. The burden of proof rests on the local authority. It is the local authority that brings these proceedings and identifies the findings that they invite the court to make.  Therefore, the burden of proving the allegations rests with them and to that extent the fact-finding component of care proceedings remains essentially adversarial. 

83. Secondly, as conclusively established by the House of Lords in Re B [2008] UKHL 35, the standard of proof is the balance of probabilities.  If the local authority proves on the balance of probabilities that the injuries sustained by I and E were inflicted non-accidentally by one of her parents, this court will treat that fact as established and all future decisions concerning the children's future will be based on that finding.  Equally, if the local authority fails to prove that the injuries sustained by I and E were inflicted non-accidentally by one of her parents, this court will disregard the allegation completely. 

84. In this case, I have also had in mind that, in assessing whether or not a fact is proved to have been more probable than not, "Common-sense, not law, requires that in deciding this question, regard should be had to whatever extent is appropriate to inherent probabilities," (per Lord Hoffman in Re B  at paragraph 15)

85. Third, findings of fact in these cases must be based on evidence.  The court must be careful to avoid speculation, particularly in situations where there is a gap in the evidence.  As Munby LJ (as he then was) observed in Re A (A Child) (Fact-finding Hearing: Speculation) [2011] EWCA Civ 12, "It is an elementary proposition that findings of fact must be based on evidence, including inferences that can be properly drawn from the evidence and not on suspicion or speculation."

86. Fourth, when considering cases of suspected child abuse, the court "invariably surveys a wide canvas," per Dame Elizabeth Butler-Sloss, P, in Re U, Re  B (Serious Injury: Standard of Proof) [2004] EWCA Civ 567, and must take into account all the evidence and furthermore consider each piece of evidence in the context of all the other evidence.  As Dame Elizabeth observed in Re T  [2004] EWCA Civ.558, "Evidence cannot be evaluated and assessed in separate compartments.  A judge in these difficult cases must have regard to the relevance of each piece of evidence to other evidence and exercise an overview of the totality of the evidence in order to come to the conclusion of whether the case put forward by the local authority has been made out to the appropriate standard of proof."

87. Fifth, amongst the evidence received in this case, as is invariably the case in proceedings involving allegations of non-accidental head injury, is expert medical evidence from a variety of specialists. Whilst appropriate attention must be paid to the opinion of medical experts, those opinions need to be considered in the context of all the other evidence. In A County Council v K D & L [2005] EWHC 144 (Fam) at paragraphs 39 and 44, Charles J observed, "It is important to remember (1) that the roles of the court and the expert are distinct and (2) it is the court that is in the position to weigh up the expert evidence against its findings on the other evidence.  The judge must always remember that he or she is the person who makes the final decision." Later in the same judgment, Charles J added at paragraph 49, "In a case where the medical evidence is to the effect that the likely cause is non-accidental and thus human agency, a court can reach a finding on the totality of the evidence either (a) that on the balance of probability an injury has a natural cause, or is not a non-accidental injury, or (b) that a local authority has not established the existence of the threshold to the civil standard of proof … The other side of the coin is that in a case where the medical evidence is that there is nothing diagnostic of a non-accidental injury or human agency and the clinical observations of the child, although consistent with non-accidental injury or human agency, are the type asserted is more usually associated with accidental injury or infection, a court can reach a finding on the totality of the evidence that, on the balance of probability there has been a non-accidental injury or human agency as asserted and the threshold is established."

88. Sixth, in assessing the expert evidence I bear in mind that cases involving a multi-disciplinary analysis of the medical information conducted by a group of specialists, each bringing their own expertise to bear on the problem, the court must be careful to ensure that each expert keeps within the bounds of their own expertise and defers, where appropriate, to the expertise of others (see observations of Eleanor King J in Re S [2009] EWHC 2115 Fam).

89. Seventh, the evidence of the parents and any other carers is of the utmost importance. It is essential that the court forms a clear assessment of their credibility and reliability. They must have the fullest opportunity to take part in the hearing and the court is likely to place considerable weight on the evidence and the impression it forms of them (see Re W and another (Non-accidental injury) [2003] FCR 346)

90. Eighth, it is common for witnesses in these cases to tell lies in the course of the investigation and the hearing. The court must be careful to bear in mind that a witness may lie for many reasons, such as shame, misplaced loyalty, panic, fear and distress, and the fact that a witness has lied about some matters does not mean that he or she has lied about everything (see R v Lucas [1981] QB 720).

91. Ninth, as observed by Dame Elizabeth Butler-Sloss P in Re U, Re B, supra "The judge in care proceedings must never forget that today's medical certainty may be discarded by the next generation of experts or that scientific research would throw a light into corners that are at present dark."

92. This principle, inter alia, was drawn from the decision of the Court of Appeal in the criminal case of R v Cannings [2004] EWCA 1 Crim. Linked to it is the important point, emphasised in recent case law, of taking into account, to the extent that it is appropriate in any case, the possibility of the unknown cause.  The possibility was articulated by Moses LJ in R v Henderson-Butler and Oyediran [2010] EWCA Crim. 126, and in the family jurisdiction by Hedley J in Re R (Care Proceedings: Causation) [2011] EWHC 1715 (Fam): "there has to be factored into every case which concerns a discrete aetiology giving rise to significant harm, a consideration as to whether the cause is unknown.  That affects neither the burden nor the standard of proof.  It is simply a factor to be taken into account in deciding whether the causation advanced by the one shouldering the burden of proof is established on the balance of probabilities."

93. Finally, when seeking to identify the perpetrators of non-accidental injuries the test of whether a particular person is in the pool of possible perpetrators is whether there is a likelihood or a real possibility that he or she was the perpetrator (see North Yorkshire County Council v SA [2003] 2 FLR 849). In order to make a finding that a particular person was the perpetrator of non-accidental injury the court must be satisfied on a balance of probabilities. It is always desirable, where possible, for the perpetrator of non-accidental injury to be identified both in the public interest and in the interest of the child, although where it is impossible for a judge to find on the balance of probabilities, for example that Parent A rather than Parent B caused the injury, then neither can be excluded from the pool and the judge should not strain to do so (see Re D (Children) [2009] 2 FLR 668, Re SB (Children) [2010] 1 FLR 1161).

I have also been mindful of the President's reiteration of the basic principles governing these types of proceedings in Re A (A Child) [2015] EWFC 11 which re-stated that it is for the local authority to prove, on a balance of probabilities, the facts upon which it seeks to rely.

Findings

I did not find CT a very credible or convincing witness. By her own admission, she did not tell medical professionals about any possible cause for the skull fracture when she was asked repeatedly about that at both the walk-in centre and the hospital. She was unable to give a convincing explanation for that failure. She acknowledged when cross-examined by Mr Robertson for the Guardian that a loving parent would not want to withhold information to medical professionals trying to treat a serious head injury. She did say that she was frightened and thought that, when mention was made of calling the Police and Social Services, that she would be blamed and this is why she said nothing. However, her failure to mention any possible trauma to LT's head started at the walk-in centre when she was asked three separate times by the nurse, Lucy Tibbett, whether LT had suffered any head trauma, banged her head or if CT had anything to tell her about the injury (H28, H104 consultation notes and J189 Police statement). Each time CT denied that anything had happened. On arrival at A&E, CT and LT were seen by Jess Carmichael, a student. Her notes are at H108 and show "no history of trauma" given by CT. CT and LT then saw Dr Babakhanlou, the specialist registrar on duty in A&E. His notes are at H117 and record "Mother denies falls, trauma or any other cause/reasons for presentation".

The first time that CT mentioned any incident involving LT suffering some kind of blow to her head is when they saw Dr Fulham, paediatric registrar to Dr Alexopolou. Her notes are at H119 and they record that CT gave a history of LT crawling between the conservatory and kitchen when she fell down a slight step forward onto her head. This is described by HP, maternal great grandmother, as "not a big event" (to Dr Alexopolou J196) and CT confirms in her first statement that LT was easily soothed and displayed no obvious sign of injury. This explanation for the injury is one which the medical and expert evidence does not support. LT fell forwards in the incident described and the skull fracture is to the left parietal bone. Dr Johnson was very clear in his evidence that this could not provide an appropriate cause for the injury (E13).

CT repeated the explanation of LT falling when she crawled between the conservatory and kitchen to Dr Alexopolou (whose Police statement is at J195-199). No mention is made of the alleged fall on the bed later in the evening of 21^st July 2015. The first time that she mentioned this was in her second Police interview on 30^th July 2015 (J132), and then in her first statement in these proceedings dated 17^th August 2015 (C24-25).

There are some discrepancies in her account of this incident. She told the Police very clearly that she was sat on the bed when LT fell over (J140). The initial description in her first statement also described her as sitting on the bed but she corrected that in evidence before me to add a sentence to the effect that she then laid down with LT in paragraph 5 on page C24. Her second statement dated 23^rd November 2015 describes her as lying on the bed (C52-53). The evidence of Liann Noble about what may or may not have been said during the parenting assessment did not really help me with this issue. Miss Lee for CT did submit that it went to mother's credibility. However, as I now know the contemporaneous notes that Ms Noble used to write that section of the assessment have been destroyed. She typed up her notes on 29^th October 2015, some weeks after the session in question which was conducted on 2^nd October 2015. Whilst she was very clear in evidence that her recollection was accurate, it seems clear from the typed notes that I have seen that CT was talking about being in the hospital and the rest of the day at that same point so it is possible that Ms Noble conflated two different descriptions.

As was submitted by Mr Robertson for the Guardian, I do note that there is a clear progression in the accounts which CT gives about the fall on the bed. It progresses from what seems to be a relatively minor response on the part of LT (as described in her police interview at J141-142) through her two statements to her oral evidence where she described LT as crying "really quite loudly" in a way that "sounded like she had hurt herself" and sobbing in her sleep afterwards.

Dr Alexopolou also gave me some very helpful evidence about CT's presentation at hospital on 22^nd July 2015. She described CT as appropriately worried, apparently open and willing to do what needed to be done and that she did not appear frightened.

On balance of probabilities, I am not persuaded that there was a fall on the bed as CT said. Her accounts vary too greatly as time has elapsed and her failure to mention it at the hospital is very telling. She was asked repeatedly at various stages whether there were any incidents of falls, blows or trauma to LT's skull and yet she disclosed nothing about the fall on the bed. If the fall was as significant as her later accounts indicate, it seems very strange that she did not mention it at all at the hospital. On CT's case the fall on the bed was a potentially innocent explanation with no apparent blame attaching to her. She was also asked repeatedly when cross-examined by both Ms Quinn and Mr Robertson as to why she didn't mention it to the medical professionals treating LT. Her only answers were that she "didn't know" and that she "panicked". Yet she is not noted by Dr Alexopolou as apparently displaying outwards signs of panicking. Taking all of the evidence into account, I can only conclude that the reason she did not mention it was because it either did not happen at all, or happened in some other way entirely.

In addition, as noted by Ms Quinn in her written closing submissions, it was quite striking that CT's responses to questions about why she had not mentioned anything at the hospital were focussed upon the impact upon CT herself rather than what was happening to LT. She said that she was afraid she was going to be blamed for causing the injury (repeating what she had put in her second statement at C54). She also said that she had lost her job as a result of the incident and had been arrested by the Police. I have no doubt that the consequences for this mother have been significant. However, I was struck by her emphasis upon this rather than LT. She did also accept when questioned by Mr Robertson that she had put her own interests before LT's at the hospital although she said that she had not meant to do this. I therefore do find on balance of probability that she failed to give the professionals treating LT a truthful account of what had occurred and by doing so prioritised her own needs over and above LT's.

In terms of the timing of the fracture, the medical evidence is clear that it cannot have occurred earlier than 2 weeks prior to the 22^nd July 2015 (Dr Johnson at E10). Coupled with this I also have the evidence of Dr Alexopolou which was to the effect that the swelling was apparently increasing when seen by various medical professionals through 22^nd July 2015. Dr Babakhanlou's evidence is the only oddity in this regard. Frankly, his Police statement seems rather unusual in that he apparently took no precise measurements but provided a guess at the swelling measuring 0.5cm to 0.7 cm – strangely precise for someone who has not measured it. The rest of the medical evidence does seem to consistently describe a swelling of around 3/4cm when seen at the walk-in centre (albeit not measured accurately by the nurse) in the morning, and then 8 x 5cm when measured by Dr Alexopolou at around 3.30pm that afternoon. No-one is suggesting in this case that the lump fluctuated in size so the evidence of Dr Babakhanlou, whilst odd, seems somehow to be either a mistake or simply measuring the lump in a way that is wholly different to Lucy Tibbett and Dr Alexopolou. The evidence of CT and HP in what they told the professionals at the hospital about the size of the lump when first seen that morning was that it was "small and gradually grew in size" (both of them to Dr Alexopolou H132), and "pea-sized" (HP to Dr Alexopolou J196). Dr Alexopolou in evidence to me also indicated that HP not only told her it was a pea-sized lump but demonstrated the size using the tip her finger. Dr Alexopolou also required a CT scan as a result of reading the measurements provided by Dr Babakhanlou. Her evidence to me was that the CT scan confirmed the measurements which she had taken. From all of this evidence it does seem to me that the lump grew in size over the course of the day.

The Local Authority has asked me to find that this and the oral evidence of Dr Alexopolou makes it unlikely that the injury was caused at 7pm on 21^st July 2015. I have reminded myself that Dr Alexopolou (as she herself said to me) is not an expert witness in this case. She gave me evidence from her perspective as a consultant paediatrician, based on her own experiences. She was very clear that it was very difficult to accurately date such an injury, confirming what she had put in her email to the Local Authority dated 12^th November 2015 in response to a question from them about this. Her professional opinion was that she would not expect obvious swelling straight away after the injury but she could not say that it did not happen at 7pm. If it had happened earlier than 3.30pm on the day before she would have expected something to be obvious before the morning of the 22^nd July but she could not say definitely that would be the case. When cross-examined by Mr Green for the father, she said that because the swelling increased in size over the course of the day on the 22^nd July 2015, in her opinion it was more likely that the injury was sustained after 7pm. On balance of probability, I find that the evidence persuades me it was more likely than not that the injury occurred after 3.30pm on 21^st July 2015 and was in fact probably after the evening of that day, and therefore whilst LT was in her mother's care.

Dr Johnson concluded that "at the time that this fracture occurred, I would expect that LT would have been in pain and showing signs of distress. This initial distress would last some moments" (E11). This was not challenged when he gave his oral evidence to me and does seem to be commonsense. In relation to item 9 on the schedule of findings, whilst the wording may not be the most elegant, I have taken this to mean that LT would have been distressed as a result of the injury and that this distress would have been obvious to her mother, who would have known as a result of that distress that LT had suffered a significant injury. I say this because, given the evidence in this case, the Local Authority are quite properly not seeking a finding that CT deliberately inflicted the injury.

Looking at the specific findings sought, I do find all of them proved on balance of probabilities with the caveat I have already mentioned about what finding number 9 is actually seeking. The cause of this fracture is therefore unexplained.

Conclusions

I have found that LT suffered an unexplained injury resulting in a skull fracture to her left parietal bone. This injury occurred whilst in her mother's care and more likely than not at some point over night on 21^st July 2015. Given my findings, I can only conclude that LT suffered an unexplained injury in the care of her mother. Beyond that I can make no other findings in respect of how the injury occurred – to do so would be to stray into the realms of speculation as it would go beyond the evidence before me in this case.