District court grants interim care order for five children following unexplained severe injuries

An Interim care order was granted in respect of five children, aged from two to twelve years old, who were previously the subject of an emergency care order. The three younger children were born in Ireland while their parents sought refugee status. The two elder children had remained with the maternal grandparents in their country of origin. They had been brought to Ireland three months earlier after their parents were granted refugee status.

The family had come to the attention of the CFA two weeks earlier when the second eldest daughter was taken to hospital with severe injuries. The child, who was put on respiratory assistance, sustained catastrophic brain damage. The explanation provided by the parents, that the child had fallen while having a shower, did not match the medical evidence.

The parents, who were present in court with an interpreter and their legal representative, opposed the application and claimed that they were not responsible for the injuries. The court heard that the parents would like their children to be returned to their care.

Also present in court were counsel for the CFA, two social workers, the detective sergeant in charge of the investigation, a consultant paediatrician, an emergency medicine consultant and a school assistant.

Evidence from Detective Sergeant

Supporting the application, the Garda Detective Sergeant told the court that in his opinion an interim care order was necessary for the safety of the children even though the investigation was still ongoing.

The interview with both parents at the Gardai station had been recorded on DVD. According to the detective, the parents’ version of events was not reconcilable with the medical evidence. The mother had said that the incident occurred at 5 pm but the parents did not seek medical assistance until 10 pm. The father had returned home from work around 7 pm. The parents had then searched in Google what to do and had conducted CPR, which could explain the delay in contacting medical assistance.

During cross-examination, the sergeant confirmed that both parents had provided statements voluntarily. According to the memo of the interview, the father had arrived home between 7 and 7.30 pm and he did not contact an ambulance until 9.50 pm. Their version of events included that, prior to the fall in the shower, the child had also fallen off a bike and had previously collapsed in a shop.

Evidence from Consultant Paediatrician

The consultant paediatrician provided a medical report in respect of the injuries sustained by the child. Giving evidence, she said that she was the paediatrician on call on the night when the child was brought to the emergency department in the hospital. On arrival the child was in a very bad condition and her level of consciousness was low. The child presented extensive external injuries including head, neck and chest superficial laceration and numerous burns and bruises. The consultant paediatrician said she did not have the photographs with her.

Judge: “When you say burn, what do you mean?”

Consultant paediatrician: “fire burns.”

There was also bruising and swelling of the perineum, subcutaneous deep bruises on the legs, haematomas on left side of the thighs, lower legs and torso and under the feet and ankles. There were also lacerations in the right thigh.

The consultant paediatrician said that, according to the plastic surgeon, the burns were recent, within 24 hours. She admitted that the other consultant would be in a better position to confirm whether it was a traumatic injury. A CT scan had confirmed that there was haematoma and swelling of the child’s brain. As there was subcutaneous tear in her vagina and cervix, the sexual assault team and consultants with experience in external injury had also assessed the child.

The parents told the consultants that the child had fallen in the shower and prior to that she had two falls from her bicycle. It appeared that there was a history of sexual abuse while the child lived with the maternal grandfather.

The consultant paediatrician said that in her opinion the injuries sustained were not consistent with a fall in the shower. The court heard that the child’s prognosis remained very poor. The girl would never walk or be able to feed herself. It was not anticipated that she would regain consciousness. “We do not expect that she will improve,” she added.

Counsel for the parents told the court that her clients maintained the child fell in the shower. When asked if there was any other explanation for the child’s injuries, the consultant paediatrician said that there was not, the child was not breathing correctly which was not consistent with the accounts given. As the child was not fully oxygenated, the delay in seeking medical assistance had resulted in a catastrophic neurological impact.

Evidence from Emergency Medicine Consultant

The emergency medicine (EM) consultant on duty on the night of the incident said that he received a phone call from the registrar regarding a child with a head injury following a fall in the shower. When the consultant arrived to their home around 11 pm, the child was in bed unconscious and had intensive head injuries.

The intensive care team were notified. The priority was to ensure that the child was able to breath in order to deal with the life-threatening condition. Once she was in the incubator, the EM consultant notified the neurologist surgeon and the consultant paediatrician who proceeded to take CT scans. The EM consultant notified the nearest Garda station as the injuries were excessive.

Through the night, more professional consultants became involved to diagnose whether the child needed surgery. “She had a severe head injury and the CT brain scan supported that. She had extensive skin injuries. It was quite dramatic,” he added.

The EM consultant met with the father first in the presence of the registrar and another doctor. They explained that the skin injuries were not consistent with a fall in the shower. The father said that three weeks earlier the child had fallen off a bicycle. The father did not realise the full extent of the injuries as he had not had a chance to observe the child through daily care. According to the EM consultant, the mother had a very similar version of events. She claimed that it was the first time she had seen the extent of the injuries.

Judge: “Would [the injuries] be painful?”

EM consultant: “They would be painful.”

Judge: “How come the parents did not notice that their child was in pain?”

Consultant: “I don’t know.”

The EM consultant said that it took him a while to get around the chronology of events. According to the parents, they found their daughter on the floor of the shower a while after the fall. They brought her to bed and tried to do chest compressions. The father had confirmed to the consultant that the child was responding at that point. The ambulance was eventually called. “There were a lot of gaps in the timeline,” said the EM consultant.

The mother indicated that the incident happened around 5 pm in the evening.

The EM consultant told the court that it would have been possible to treat the head injuries at an early stage by providing oxygen and freeing the pressure of the swelling. Regretfully, when the child arrived at the hospital it was too late. The EM consultant had had no contact with the parents since then.

Evidence from Social worker 1

The social worker told the court that when she met with the parents they explained their daughter had fallen down in the shower and she had had many falls prior to that. According to the parents, their daughter had a problem walking and had fallen a number of times since she arrived in Ireland with her sibling three months earlier.

The father told the social worker that he was at work when his wife called him to inform him their daughter had fallen in the bathroom. He did not know when he would arrive home. Neither parent was able to say for how long she was unconscious.

The parents told the social worker that they did not notice the bruises or burns on their daughter’s body prior to the incident.

The court heard that the parents had supervised access with their four other children since they were taken into emergency care. The visits went well but when access ended the parents  the children became very upset. It was a traumatic experience for all parties. The social worker confirmed that sibling access between the children would be facilitated.

During cross-examination, counsel for the parents said that her clients’ position remained that their daughter had had previous falls from a bike.

Counsel for the parents: “These are parents who love their children very much. They are very distressed by all the screaming. Would you agree that the situation is quite emotionally charged?”

Social worker: “The parents would have to develop certain skills to learn not to add to the high level of distress to the children.”

Counsel for the parents said that her clients love their children very much and that they would like to have more access. The social worker admitted that the children and the parents showed reciprocated love during the access visits. Counsel asked the social worker when the next access visit would take place. The social worker answered: “We would like to meet the parents to discuss.”

Evidence from the school assistant

The school assistant said that the girl had attended school 10 days out of the 17 days before the end of term. She found it difficult to communicate due to the language barrier. Children would talk to her but she was quite reserved and she just sat quietly. She would not go anywhere or do anything. She often had no lunch with her so her older sister would give her some lunch. The child made a friend with the school assistant, who often encouraged her to take part in fun activities such as making sand castles.

One day, the school assistant noticed that the child had bruises under both cheeks. The next couple of days she did not attend school. On the last day of term, the girl hugged the school assistant and told her: “Thank you for being my friend and not making me feel sad.”

Judge: “Did you ever observe any difficulty with the little girl walking?”

School assistant: “No, she could walk, no issue with it.”

Judge: “Anything else you can recall? Did she fall in the grounds or play yard?”

School assistant: “No”

Counsel for the parents said that the social worker, who had provided support to the family during the last year, had advised to take the child to the doctor for a general examination since she had just arrived in Ireland. The parents had intended to register with a local general practitioner but they admitted that they could not afford the fee.

Evidence from Social Worker 2

The court heard that the social worker had been assigned to the case when the child was already in hospital and seriously ill. She had met with the parents on a few occasions and during the access visits. Their level of English was good and she was able to communicate with them. The parents had not provided her with any additional explanation.

The social worker was concerned because there was no explanation for the catastrophic injuries to the child. “I am worried about the risk to the other children. Her siblings were present for whatever happened,” she added. The injured child had been moved to the public ward in the hospital, where there was a Garda presence.

The social worker told the court that the return of the children to their parents would have a negative impact on their health. The second youngest child, who was a toddler, scratched her face every time she got upset. The social work team wanted the parents to continue engaging with their children and would prepare an access visit schedule. However, they were looking for a different venue because the family centre was no longer suitable for access.

During cross-examination, the social worker accepted that the parents wanted the children returned to their care and that their explanations of what had happened had been consistent throughout.

When asked whether she had spoken to the other children about what happened, the social worker said that two of the siblings were just toddlers. The eldest daughter was very pleasant and wanted to return to her parents. She was significantly upset after seeing her sister, to whom she was very close, in hospital. When she was asked about what happened, she said her sister had fallen in the shower. The social worker admitted that she had not discussed with the eldest child how life was with the maternal grandparents before they came to Ireland just over three months earlier.

Counsel for the parents insisted that her clients engaged well with the children and that the children had shown they loved and missed their parents. “When they are with their parents they are ‘happy-go-lucky’,” counsel added. The social worker accepted that the parents had been frequent visitors to their injured daughter since she had been admitted to hospital and that the circumstances were naturally distressing.

Counsel for the parents: “In terms of trying to progress the case, what would [the parents] need to do to have a better chance?”

Social worker: “It would be difficult to plan as we don’t know what happened to the injured child.”

Counsel for the CFA asked the social worker what was the conclusion, in relation to the CFA’s signs of safety scale of 0 to 10, having considered the strengths and weaknesses of the case. The social worker confirmed that the score in the scale was 0 since the explanation for the child’s injuries did not match the evidence given. “The children are vulnerable,” said the social worker adding that the child had not been seen by a GP since she arrived in Ireland.

Counsel for the parents told the judge that her clients reserved their position and declined to give evidence at that point.

Findings

The judge said that the application pursuant to section 17 of the Child Care Act 1991 had been brought by the CFA for an interim care order in respect of five children from the ages of 12 to two and that the standard of proof to satisfy the statutory threshold was on the balance of probabilities.

The judge noted that the respondent parents were in attendance in court and, through their counsel, had indicated their opposition to the application. The Garda detective had outlined that he was conducting an investigation and fully supported the application. The consultant paediatrician gave evidence outlining that the child’s level of consciousness was low when she received a call from the registrar in the Hospital Emergency Department and that the injuries sustained upon the child were extensive.

The emergency consultant who called to their home at 11 pm that night had outlined that the level of bruises and burns suffered by the child were unusual in the circumstances. The child was found around 5 pm but the parents had not called the ambulance until 10 pm. During the meetings with the social worker, the parents explained that the child had difficulty walking and had had many falls. However, the school assistant had not observed this difficulty when the child attended school although she had noticed some bruises. The respondent mother and father had declined to give evidence.

As the explanation given by the parents was not in keeping with the child’s injuries and there was significant delay in calling medical services, the judge was satisfied that the five children require care and protection and granted the interim care orders.

Extension of interim care order

The District Court granted an extension of the interim care orders a month later. The parents were in custody and consented. The fifth child, who had suffered a serious injury, was in hospital. The judge noted the consent and was satisfied that in the circumstances it was appropriate to extend the interim care order for 28 days.

The parents, who are non-Irish nationals, were present in court on remand and they were represented by a barrister. They required the assistance of an interpreter who was sworn in before the court and sat between the parents to interpret the proceedings.

The barrister for the CFA told the court that there were two reports before the court to support the application. She said that she had been intending to seek a section 47 direction in relation to the children going to school but that as the parents have now given their consent this application had been withdrawn. The older children had been moved to another county in Ireland and they were unable to continue in the school that they had previously been attending.

The CFA social worker had a report before the court and gave evidence. The two older children were placed together in another county in Ireland earlier in the month and the CFA was happy with the care they were getting. As the CFA now had the consent of the parents they would start school as both of the children had been saying that they wanted to go back to school. The social worker said that A, the eldest child, was doing well but that she was upset and talked to her carer about being on her own and it was particularly difficult for her as she was not familiar with this country.

Child A fought a lot with Child B but the social worker told the court that she cannot read a lot into that at the moment. The social worker said that A found it hard to go to sleep at night but that once she was asleep the child slept well and ate very well. She said she thought in time A would need some therapeutic work as she was particularly closed, at the moment but she was not ready for this yet. The social worker said that B was doing well and was a very gentle child. Both children were very mannerly, grateful and thankful. The social worker told the court that the most important thing was to get the children to settle and have a placement that could be long-term. Although the court was not near to making any long-term decisions their capacity to stay in the placement and get back into school was really important.

A and B had frequent contact with their brother and sister and they needed to get into a routine with this contact and potentially look at access with the mother and father who they had not seen since the initial care orders were made.

CFA barrister: “In respect of access with all four children and parents, at what stage are you with that?”

Social worker: “We have to plan very carefully with that.”

The social worker said that originally both parents did not want the children coming to visit but that she did inform the parents before court that the children were asking where their parents were and the social worker had to tell the children as there was no way to say it “in a more diluted form”. Taking all of that into account the social worker said that they needed to plan the right therapeutic intervention and the children’s readiness.

Social worker: “We do have to plan in relation to access. A lot will depend on the parents with further applications for bail and we can sit down at the point and can review it then.”

In relation to the younger children, Child C and Child D, they had been longer in their placement and were beginning to settle. The social worker said that the last two weeks had been better for the children. Their sleeping routines were very difficult. One of the children had a lot of distress going to bed and cried. The foster carer did tell the social worker that in the last week this had improved and they were sleeping better.

Social worker: “Both children need lots of attention and are always looking if the carer is around, which is appropriate given the situation. The carer is very attentive to that and is always with them as opposed to separating them.”

The social worker gave evidence that the fifth child remains in the children’s hospital and the situation has not changed as she has not regained consciousness. The social worker gave evidence as to the medical treatment this child was getting and that she was getting different treatment “to sustain what quality of life she has at the moment”.

The social worker said that the father’s brother had been visiting her in hospital regularly and he came in every day. The father’s brother had indicated that he wished to be assessed as a foster carer and the social worker had made contact with him in the hope of meeting him in relation to being assessed. Another maternal relative had visited the hospital but the parents had indicated that they did not wish this to continue and they wanted to know if this relative’s interest was genuine because they had had no contact in a long time. The social worker said that they would meet with this relative and give feedback to the parents in relation to that. The opinion of the social worker was that the children should remain in the care of the CFA.

The social worker agreed with the parents’ barrister that she had a productive conversation with them. The parents had expressed a wish for the children to be reunited in care and the social worker had outlined the difficulty in relation to that.

The parents had expressed a wish for the father’s brother to take care of all four children and to be facilitated with access as soon as possible. The parents were anxious to see the children at prison visits and made that request to the social worker. The social worker said that there had to be a discussion around it as there were a lot of logistics involved and preparation required but that hopefully these visits could be implemented when the status was clear in the next week or so. The social worker said that they needed to plan carefully in relation to access visits as access previously was very difficult.

Counsel for the parents told the court that the mother had expressed a reservation about disclosing their current incarceration to two of the children and she was distressed by that. The father understood the reasons why the children were told but found it very distressing overall, but particularly for the children. Counsel for the parents indicated that they were otherwise consenting to the interim care order.

The court-appointed guardian ad litem (GAL) to the children prepared a report for the court and supported the application for an extension of the interim care orders on the basis of the welfare, health and development of the children and the fact that there was nobody else in a position to care for the children.

Judge: “In terms of individual needs of the children, are they being met?”

GAL: “Yes, judge.”

Judge: “Are they receiving all appropriate supports at this time?”

GAL: “Yes, judge.”

Judge: “Do you agree with evidence by the social work team leader today?”

GAL: “Yes, judge.”

Judge: “Are you in agreement with access being explored with the parents?”

GAL: “Yes, judge.”

Judge: “And access between siblings also?”

GAL: “Yes, judge.”

Judge: “Are you satisfied an order in respect of each child is in their best interest?”

GAL: “Yes.”

Counsel for the parents had no questions for the GAL.

The judge noted the consent of the parents for an extension of the interim care order for 28 days. The judge was satisfied that in the circumstances that continued to exist it was appropriate to extend the interim care order. The judge also set a date one week in advance of the next date for production orders to be made in respect of the parents.

The barrister for the parents made an application for costs as the reports were not received until the morning of court and he understood that the GAL had a difficulty with a contact address. The CFA indicated to the court that they were opposing the application for costs according to the principles in CFA v OA 2015. They had agreed the costs of the initial application and the parents were going to seek legal aid. The CFA also said there was no formal application before the court. The judge said that as the application had been moved before the court she would consider it but decided to made no order for costs.