Warwickshire County Council v AQ
| Jurisdiction | England & Wales |
| Judge | Walker |
| Judgment Date | 14 August 2020 |
| Neutral Citation | [2020] EWFC 56 |
| Docket Number | Case No: CV19C01714 |
| Date | 14 August 2020 |
| Year | 2020 |
| Court | Family Court |
[2020] EWFC 56
IN THE FAMILY COURT
IN THE MATTER OF THE CHILDREN ACT 1989
Coventry Family Court
Little Park Street
Coventry
Her Honour Judge Walker
Case No: CV19C01714
Mr Sampson QC for the Local Authority
Mr Vine QC and Miss Steele for the First Respondent instructed by Kundert Solicitors
Miss Buxton for the Second Respondent instructed by Rotherham & Co Solicitors
Miss Connolly QC and Mr Kennedy for the Third Respondent instructed by Jackson West Solicitors
Mr Lewis for the Fourth, Fifth and Sixth Respondents instructed by Johnson and Gaunt Solicitors
Hearing dates: 6 th, 10 th, 11 th 12 th, and 14 th August 2020
These are care proceedings brought by Warwickshire County Council in relation to three children; K (who is about to be 12 years old), L (who is 4) and M (who is approaching his first birthday). Their mother is AQ (the mother henceforth). M's father is BP (I will also refer to BP as the father for ease in this judgment that relates largely to his child). CR is L's father and the father of K is DS. Very early on in the proceedings I determined that DS should not be served with notice of the proceedings, on the basis that he had had nothing to do with K since she was a baby, had been violent and abusive towards the mother and was still involved in violent crime. The mother was terrified that he would learn of her current whereabouts.
The children are represented in these proceedings through their Guardian, Karen Hughes. The care proceedings were issued on the 19 th December 2019 and so are now in week 34.
This is a fact-finding hearing which has sought to establish the likely cause of injuries sustained by M as long ago as December last year. I can only apologise to M's parents for the delays that have occurred in this case, largely as a result of the COVID 19 pandemic that has affected every part of our society. The only comfort to them and the court is that M, K and L have remained cared for within their family, with the help and support of their maternal and paternal grandparents, who have supervised both the mother and the father in their care of M. Due to their exemplary care of the girls, and the analysis of risk being much lower, the mother and the father have been able to have the unsupervised care of the girls. In so far as is possible, the lives of the children have been able to continue without too much disruption. The local authority has had the benefit of an interim supervision order since the 20 th December 2019.
This situation has also had the benefit of allowing for the girls being able to spend time with CR. Although he is not her father, K has a warm and loving relationship with him, and she and L spend approximately five nights out of every fourteen in his care. I gave my permission for CR to be have a representative present during this hearing, even though the factual issues do not relate directly to him, as any findings that I make may have implications for L and it was important that he properly understand the evidence I have heard and the basis for my decision.
The local authority's final schedule of findings sought is dated the 11 th July 2020, and the parents have responded to it, although as I will set out in this judgment, at the conclusion of the oral evidence, the local authority sought to amend the findings sought.
Background to the application
M was born at 33 weeks gestation at Warwick Hospital without intervention, but shortly after birth, he was showing signs of struggling to breathe. Within twelve minutes of birth, he was transferred to SCBU. Soon after, it was necessary to transfer him to Leicester Royal Infirmary. So began a period in which M suffered from a number of periods of ill-health.
Within her second statement of evidence, the mother set out a list of medical appointments that she could recall M attending in his first weeks of life and I repeat it here;
| 24 th August | M born at Warwick Hospital and transferred to Leicester and ventilated |
| 28 th August | Transferred back to Warwick |
| 5 th September | Discharged home |
| 7 th September | Midwife appointment at home |
| 12 th September | Health visitor appointment at medical centre |
| 20 th September | Health visitor appointment at medical centre |
| 1 st October | M admitted to Warwick hospital for suspected bronchitis |
| 3 rd October | Ultra sound scan performed on kidneys and discharged home |
| 7 th October | GP appointment |
| 9 th October | Six-week check at health centre |
| 10 th October | M and mother at HV clinic seeking advice – telephone consultation with GP |
| 11 th October | GP consultation |
| 14 th October | Health Visitor contacted re blood in stools – GP appointment met and admitted to hospital |
| 15 th October | Discharged home |
| 16 th October | GP appointment |
| 17 th October | Hearing appointment |
| 20 th October | M taken to out of hours GP at 11.45pm due to breathing difficulties |
| 23 rd October | Weighed at health centre/first immunisations |
| 24 th October | GP appointment — referred to urology |
| 27 th October | Taken to out of hours GP as a result of diarrhoea |
| 28 th October | M admitted to Warwick hospital and discharged |
| 30 th October | Appointment with Dr B at Warwick Hospital |
| 6 th November | Routine immunisations |
| 11 th November | Outpatient appointment at ENT Warwick Hospital |
| 19 th November | Bloods taken |
| 27 th November | Weighed at health centre |
| 28 th November | Telephone consultation with GP |
| 29 th November | Hearing appointment |
| 1 st December | Admitted to Warwick Hospital |
| 4 th December | M transferred to Stoke University Hospital |
| 10 th December | Returned to Warwick Hospital |
On the 8 th December 2019, the local authority received a referral from Stoke Royal Hospital. M had been x-rayed on the 3 rd December at Warwick Hospital, but those pictures were understood not to have established any abnormality. However, when Stoke Royal Hospital reviewed the x-rays the next day (on the 4 th), they indicated a fracture to the 7 th rib and a suspected fracture to the 6 th rib. He was transferred back to Warwick Hospital on the 10 th December. That same day, the local authority held a strategy meeting and determined that there should be a s47 enquiry.
A child protection medical had been undertaken whilst M was in Stoke by Dr X. That reports says this,
“Whilst he was on the intensive care unit, it was noted by our consultant paediatric radiologist that there was evidence of a fracture of the 7 th rib on the left side with some evidence of healing. These were on x-rays done for assessment and management of Ott's respiratory condition. There was also the suspicion of a fracture on the 6 th rib. On review of the x-rays done at Warwick Hospital, it was apparent that the changes in the 7 th rib were present on the first x-ay done on presentation on 3/12/19. The radiology report suggested that the appearance was highly concerning for non-accidental injury. The findings of the x-rays were discussed with M's mother. She was not able to remember any event that could have resulted in this injury.
As part of this court's enquiry, permission has been granted to instruct two experts; Dr Karl Johnson, paediatric radiologist, and Dr Ahmad, consultant paediatrician. Dr Johnson's first report is dated the 8 th April 2020 but that report was quickly superseded by one dated the 15 th April. He was provided with the chest and abdomen x-rays that had been taken at Leicester Royal Infirmary on the 24 th August, along with the chest x-ray taken the next day. He was also given the chest and abdomen x-rays taken at Warwick hospital on the 24 th August and a chest x-ray taken on the 1 st October. He also reviewed the chest x-rays from Warwick hospital on the 3 rd and the 4 th December, and the full skeletal survey performed on the 24 th December. From the Royal Stoke University Hospital, he reviewed a chest x-ray taken on the 6 th December, a full skeletal survey from the 9 th December and a CT chest scan from the same day.
His written conclusions can be summarised as follows;
(1) There is normal bone density with no evidence of underlying metabolic bone disease.
(2) No fractures can be seen on the x-rays taken on the 24 th and 25 th August or on the 1 st October.
(3) On the x-ray of the 3 rd December, there is a healing fracture of the posterior lateral (back and side of the chest) of the left 7 th rib that is between 3–8 weeks old on the 3 rd December (giving the window as 8 th October – 12 th November)
(4) There is the possibility of a healing fracture to the posterior lateral left 6 th rib, which, if present, is also 3–8 weeks old at the same date.
(5) The subsequent x-rays do not change that clinical picture.
(6) A rib fracture is the result of a significant force applied to the bone, in excess of normal handling
(7) Rib fractures are typically the result of severe excessive squeezing compressive force applied to the chest
(8) An isolated rib fracture could alternatively possibly occur from a direct blow or impact at the site of the fracture
(9) Dr Johnson was not aware of any child suffering a rib fracture as a result of physiotherapy who had normal bone strength and density although there have been some reported cases outside of the UK
(10) He would defer to the paediatricians as to the effect of M's prematurity on his pre-disposition to sustain fractures.
Dr Johnson was then requested to answer a series of written questions, which he did by email on the 1 st June 2020. Unsurprisingly, he was asked to give additional information about the possible fracture of the 6 th rib. He responded,
“Healing rib fractures are typically seen as some degree of swelling and expansion of the rib. The degree of expansion of the...
To continue reading
Request your trial