Infant in CFA care sustains an unexplained leg fracture – 2021vol1#27

During an application for an extension of an interim care order in respect of an infant girl the court heard that there had been an “unfortunate incident” whereby she had sustained fractures to her leg. The child was in a placement with the mother’s cousin. Both of the parents were legally represented and they consented to the extension of the interim care order on a without-prejudice basis. The judge was provided with an updated social worker’s report and also a signed safety plan.

A medical report had been updated that morning prior to the court sitting and the CFA solicitor told the court: “She appears to have sustained three fractures and potentially a fourth that might be the same injury or an old injury.”

The solicitor said that it was unknown how the child had sustained the injuries while in the care of the CFA. She said that due to their concerns the investigation was ongoing as they were unexplained injuries. The solicitor told the court that a signed safety plan had been implemented and the placement was being supervised by another family member.

The court was told that the guardian ad litem (GAL) had concerns in relation to the child remaining in the placement with the unanswered questions in respect of the injuries, and she had requested the written safety plan. The CFA solicitor said that another social work team was conducting an investigation and she described it as a “difficult situation”.

The medical report from the hospital outlining the injuries stated that the hospital was not taking a view at that stage of whether it was a non-accidental injury. The general paediatric doctor had some questions for the orthopaedic team in respect of the possible causes or whether there was an issue with the child’s bone density and also had questions in respect of the timeline of the fractures.

The solicitor told the judge that there were more investigations to be done. Referring to the child remaining in the placement, she said that “on balance” it was felt that the child should stay, with another adult present on a 24-hour basis, due to the attachment the child had to the placement and the level of care to date. She said that the CFA was “monitoring very closely” and appreciated the GAL’s concerns.

CFA Solicitor: “It is a balancing act, between the potential of harm and welfare, and the investigation is ongoing.”

The solicitor reassured the court that the CFA would keep the GAL informed.

The solicitor for the mother confirmed that the mother was consenting to the extension of the interim care order on a without-prejudice basis.  He said that the mother was of “the firm view” that the foster carer had always provided a loving environment and a high standard of care. The solicitor added that the mother was concerned about the injury and was in agreement with the proposals to support the placement and for the child to remain in the placement during the investigation. The mother also requested that access recommence “as a matter of urgency” and asked that she be supported in that access given the late stage of her current pregnancy.

The lawyer for the father said he was also consenting to the extension of the interim care order on a without-prejudice basis.

Father’s solicitor: “He is of the same view that the current placement is the best place unless some other information comes to light.”

The solicitor for the GAL said that he had communicated to the CFA the GAL’s “serious reservations” the previous week. He said that the social work department had made decisions on planning over the weekend that “the GAL didn’t entirely concur with”.

GAL’s solicitor: “The GAL is not proposing to rupture the placement immediately but an unexplained serious injury has occurred in unexplained circumstances. The GAL has a duty to the child and to the court and she has extensive reservations.”

The solicitor said that the GAL respected the decision made by the social work team and the people immediately charged with these determinations but said there was still an unaccounted for and unexplained injury. The GAL wanted there to be orthopaedic input into the evaluation and the solicitor said there was “no conclusive determination at this point”.

GAL’s solicitor: “In a guarded way the GAL accepts the status quo and was provided with an updated safety plan. Safeguarding seems proportionate and necessary given the serious concerns.”

The solicitor said that the GAL had “championed that family placement at the time” when it became available and was assessed. He said that the GAL viewed it as a committed placement and hoped that it was maintained but given the injuries, she had a “serious concern”. The court was told that the GAL supported the extension of the interim care order with a clearly documented safety plan and an independent and timely assessment.

The allocated social worker gave evidence and provided the court with an update. She said that she was satisfied that the grounds giving rise to the initial interim care order continued to exist and the child’s welfare required the interim care order to be extended.

Judge: “How is the child at the moment?”

Social worker: “I saw her last night and she was eating and sleeping well. She is in a cast but trying to move around. She is a happy baby. She will be reviewed in one week and in two weeks’ time.”

The GAL gave evidence to the court and confirmed that she supported the extension of the interim care order and that she was furnished with the signed safety plan.

GAL’s solicitor: “What is your view of the ability to safeguard the child pending the outcome of the investigation?”

GAL: “The social work department are trying to put the jigsaw together. I am concerned that the explanations given to date are inconsistent with the injuries and in those circumstances there is concern.”

The GAL said that she had met with the consultant that morning and had requested that the hospital would reconsider and add to the report for a thorough view on the injuries. She said that the hospital had updated the report with one line “that non-accidental injury could not be ruled out” and that the injuries may be accidental or non-accidental. The GAL wanted the baby to be seen by the orthopaedic department and for a further more definitive opinion on the bone breakages and a more definite view of whether the explanations provided were acceptable.

GAL’s solicitor: “The social workers are to carry out a thorough risk assessment and an independent assessment.”

GAL: “Parts of the story are vague. An assessment needs to be done thoroughly. A baby doesn’t crawl or walk too much and it is hard for a baby to sustain such injuries. There is a piece of the puzzle missing and it is up to the child protection agency to try and piece it together.”

The GAL said that she had firm recommendations to the court about the care plan and it was “very much on that basis” the child was remaining in the placement.

GAL: “I understand it is a difficult decision as the medical opinion to date is not very clear. We need to go back to the experts and get a more expert opinion on this.”

The GAL described the placement as a “superb placement” and said that the child was “very emotionally connected with the foster carer”. The GAL said that the doctor had commented that in such situations the parenting might be questioned but the doctors had noticed that when the foster carer had left the hospital the child had “sought the foster carer out”.

GAL: “Everyone is emotionally invested in the placement but there is a responsibility that she comes to no danger. The safety plan at the moment is safe and the social worker has assured me that there will be further checks as needed.”

The GAL told the court that there was a full-time family member living with the placement to supervise and she had met the family member the previous day and had “no concerns that the person was not available for twenty-four hours a day”. The GAL said that there were questions that she would like to see answered to inform her assessment.

GAL: “We may not get certainty on this but we need a very definite balance of probabilities.

We need to be very clear that she will come to no harm if she remains in the placement. If there is any concern of further harm the CFA need to make further recommendations.”

The GAL had met the baby the previous day. The child had been wrapped up in a blanket and being fed a bottle.

GAL: “She has a cast from her toes to the top of her leg and it is very difficult to see I suppose, but she was being cared for appropriately at the time I was there. She looked fine as a little baby, but four fractures, that can’t be lost on any of us. There is a question mark to get to the bottom of this as soon as possible and to make the best decision for her as soon as possible.”

Judge: “There is a query in the doctor’s report that there could have been a previous injury?”

GAL: “It is a huge red flag and raises concerns about physical abuse. [We are] not able to say categorically [there was] a previous injury. It could be involved in the current injures and healed quicker so cannot definitely say an old injury.”

The judge said that he noted the consent of both parents and having read the reports and heard the evidence he was satisfied that the threshold had been met and the circumstances giving rise to the initial interim care order continued to exist. The judge extended the interim care order for twenty-eight days.