Monday, 4 July 2011

SBS: New Zealand: Kahui twins inquest

27 Jun 2011  Dan Satherley

The final stage of the inquest into the deaths of South Auckland twins Chris and Cru Kahui continues this morning.
The three-month-old babies died five years ago this month after being admitted to Starship Hospital with head injuries. The babies' father, Chris Kahui, was acquitted of their murder in 2008. 
Testimony from family members and friends of the Kahui family has taken a significant amount of time, including testimony from Chris Kahui. There was hope that if new evidence came to light during the inquest police would reopen the case, but that hasn't yet happened.
Coroner Garry Evans has said he wants to make it mandatory for health professionals to report any signs of child abuse to the correct authorities. reporter Dan Satherley is in court today and will bring you live updates of the inquest.
3:18pm – “A baby who had one traumatic head injury in a particular social environment is at risk from another,” says Dr Kelly, referring to a previous head injury baby Chris had suffered prior to the blow that killed him, but says the evidence doesn’t show it was material in his death.
Dr Jenny says research has shown multiple occurrences of the same injury can lead to worsening complications, but believes in this case whatever was done to baby Chris the night before he died was enough to wholly explain the result.
Dr Kelly describes what physical process it was that killed the twins - bridging veins on the brain being torn. He says it’s hard to know exactly how much force is required for this to happen on any one particular person in any particular situation.
“It’s very hard to define that precisely - you can’t do experiments with babies where you apply force and see what happens.”
He says what is known is there needs to be very strong acceleration or deceleration to tear the bridging veins.
“Impact vastly increases the amount of deceleration.”
“It used to be known as ‘shaken baby syndrome’ but we know now not all of these babies are just being shaken – they’re being slammed, shaken and dropped. Mr Kelly says there were clearly impacts to Chris’ head, and though he admits Cru’s brain injuries could have been caused by vigorous shaking, he is almost certain Cru was also “slammed”.
The rest of the panel agreed with Dr Kelly’s opinions.
Dr Kelly says there was “extensive haemorrhaging” on both twins’ retinas, which was consistent with a deliberate attack.
“In about 80 percent of children with inflicted brain injuries in this age group, you will see bleeding onto the retina,” says Dr Kelly.
“It’s very uncommon in accidents,” says Dr Jenny - not without having a child’s head completely crushed.
“When you look in the eye and you see that blood everywhere, you go, ‘oh dear...’.” Extensive computer modelling of infant eyeballs and studies with crash test dummies back up this view, says Dr Jenny.
Dr Kelly was asked how easy it was to break a baby’s leg, whether it could happen accidentally, or more force was required.
“I have never done it, I’m glad to say,” says Dr Kelly. He says it would be easier to break a baby’s femur than an adult’s - it sometimes happens during labour but Dr Kelly says the kind of force required to break a baby’s leg is “well outside” what you’d apply in day-to-day interactions with a baby.
2:52pm – “My understanding of the evidence is that the twins were feeding four-hourly up until around a week before they were admitted [to hospital],” says Dr Kelly, who notes in that last week, they were feeding only every six hours - quite a long time for babies that young.
Dr Kelly says if the last feed before the incident was around 5 or 6pm, they should have been awake around 11am or midnight for their next. By 2am, the twins’ parents should have been “anxious” that they were yet to wake.
“If they didn’t rouse by two o’clock in the morning, it should have been obvious there was something very wrong. Most parents at this stage wake in anticipation of their baby feeding. “If it is correct they never fed again after five or six o’clock,” says Dr Kelly, the head injuries must have occurred between then and 2am.
If baby Chris’ last feed was the one his mother gave him at midday, he should have been awake by 6pm at the latest - if he was still sleeping at 8am, this would imply his injuries were received prior to then.
2:44pm – “In terms of inflicted head injury [on young children], we now see at least one a month,” says Dr Kelly.
In the five years since the Kahui case, Starship has dealt with about 60 cases of deliberately inflicted head injuries in children under three years of age, the “majority” of them under one.
2:25pm - The inquest resumes after lunch. Counsel Simon Mount asks the panel if they agree that a) Chris and Cru each received primary brain injuries, b) it was these injuries that killed them, and c) if Ms Saunders testimony that the babies seemed normal at the time she fed Cru - around 1pm - then they had not yet received the injuries that killed them.
The panel unanimously agrees.
1:00pm - Dr Jenny says kids who have been deliberately injured often have worse outcomes than those accidentally hurt, because in accidents, responsible adults generally get in touch with emergency services right away, but the Kahuis’”ates were sealed” because no one sought them care right away.
The night before they were taken to hospital, Cru had stopped breathing, but wasnt taken to hospital because he began breathing again and Chris Kahui and his grandfather thought he looked “okay”.
“Humans have a tremendous inner drive to stay alive so I’m not surprised he started breathing again,” says Dr Jenny, but that this could happen even with serious brain damage.
12:51pm - All four of the panel agree that if Chris Kahuis feeding of the twins around 5pm went fine, then the fatal injuries must still have been yet to come.
12:48pm – “It’s possible that his conscious state was normal,” says Dr Donald, but he isn’t entirely convinced Cru’s brain injury hadn’t already been delivered. The rest of the panel on the other hand, are fairly certain.
“It seems to me quite consistent with a one-week-old’ behaviour,”says Dr Kelly.
The Kahui twins were born 11 weeks premature, and were 12 weeks old when the incident occurred, so would be physically as developed as most one-week-olds.
Dr Jenny says it is clear baby Chris had not yet incurred the broken femur he would receive. She says the testimony from Chris Kahui that baby Chris fed just fine suggests he was still healthy and unhurt. Babies with a broken femur are best left lying still she says, as picking them up greatly increases the pain -the subsequent crying would have been a clear sign something was wrong, and this wasn’ supported by the evidence.
12:39pm - The panel believes when Chris Kahui’s cousin April Saunders gave Cru a bottle, around 1pm, the baby was unlikely as yet to have suffered any serious injuries.
His state is what it has been up until that point, and both his aunt and his father say his state had not changed, says Dr Jenny.
Dr Donald acknowledged Cru could have sustained a minor head injury without Ms Saunders noticing because she did not have a chance to interact with the infant, whom remained sleepy during the feeding. Cru had already had a feed administered by his mother only an hour or two before, and had been sleeping.
But it is unlikely to have been the injury that led to his death.
If he had a lesser head injury on the Monday, it would likely to have had an effect on his conscious state, which was not assessed,” says Dr Donald.
“If April could have been able to engage with him say ‘goo goo, ga ga’,” then Dr Donald says he could have come to a better conclusion.
“It sounds as though the feeding in the morning with both his mother and father, from what I’ve read, they were awake and interactive,” says Dr Donald.
“They were, as far as the severe primary head injury is concerned, they were normal in the morning,” but as Cru mostly slept through the top up feed with Ms Saunders, he can’t make a call on his state at that time.
Dr Jenny says she cannot see anything nothing unusual in the description of Ms Saunder’s feeding of Cru.
Dr Kelly says Ms Saunders was an experienced mother, and if she says Cru seemed normal, there is little reason not to assume that was the case.
12:09pm - Dr Kelly says in his experience, parents are the best judges of whether anything is wrong with their baby.
He believes Chris Kahui had enough hands-on experience bringing up the twins that it would be fair to believe him that nothing was wrong with Cru earlier that day.
“He fed them regularly, he changed them and he knew their normal behaviour. You also listen to the parent or caregiver or adult that knows the baby.
“If the parents say the baby is normal, they are the best judge of that... from the perspective of what happened that Monday, if Chris states that Cru was normal... I’d imagine that was a reliable observation.”
11:31am - The panel says they believe that Cru could not have sustained the primary brain injury prior to his lunchtime feed.
Dr Jenny says she has never seen a baby with a serious primary brain injury take a feed, not even for the first two weeks following the injury.
11:08am – Professor Jenny says she thinks it is very clear that the apnoea occurred after the serious head injury.
“There’s no doubt in my mind he was injured before that occurred.”
She says the evidence points to the injury to Cru occurring between the 2:30pm feeding session and the 8:30pm sleep apnoea incident. She says after the injury occurred, there’s no way Cru could have fed properly.
“Both of the boys had very high levels of sodium in the blood, Chris more so than Cru. That would indicate to me... they were really quite dehydrated, and that would be consistent with going for a very long time without feeding.”
She says they could sometimes go for 12-14 hours without feeding.
“They fact that they went for this prolonged time and no one seemed concerned that they hadn’t eaten for hours and hours, I find quite mystifying.”
10:59am – Professor Jenny says it is unlikely Cru would have been able to be fed after being injured to the degree he was.
“Often that’s how we realise a baby is brain damaged – the difficulty of taking a feed,” she says.
“The nature of Cru’s injury was that he had serious primary brain injury [immediate damage]. He had tears in the actual cortex of his brain, and I can’t imagine that a child with that level of damage would have been able to feed.”
She says the fact he could eat, and settled down just fine after feeding, suggests no serious brain injury at the time. If he had a concussion, it’s possible he still could have taken a normal feed, but as Cru was later found with serious primary brain damage, this is unlikely.
Both twins had severe retinal damage, which Prof Jenny says correlates closely with the force used in an attack.
10:49am - The members of the expert health panel have been sworn in – Dr Donald, Prof Jenny, Dr Biard and Dr Kelly.
Dr Kelly says the twins died of a severe head injury, which was non-accidental – “in layman’s terms; child abuse”.
The force “certainly involved impact to the head, probably from being slammed against a surface.”
Dr Kelly says Cru would have been injured in a similar matter.
“My view is that on the evidence available was that Cru was normal (at the time of feeding in the afternoon). With Chris, the evidence is a little unclear... it is of my opinion the twins were normal around midday on Monday and if they were normal at that time, the injury must have happened later that day.”
Dr Kelly can’t be certain, but suspects Cru’s troubled breathing happened immediately after being hurt.

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