16. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen.
17. We have done this and have found no indications the Trust did anything wrong.
18. Mr N says the Trust misdiagnosed his son with two fractured wrists and a fractured femur. Mr N says this led to his son and his other two children being removed from his care by social services.
19. The Trust explained that once staff diagnosed Master N with a skull fracture, they ordered a full skeletal survey which is a standard investigation to look for any additional fractures.
20. The Trust said the skeletal survey reported on the 10 April showed:
‘Abnormal appearances of the metaphysis [bone] involving the left distal radius [end of bone near wrist] and ulna [forearm], the right distal ulna, and the metaphysis of the right distal femur [thighbone]. These are suspicious for metaphyseal corner fractures’.
21. The Trust tells us the skeletal survey was reported by two paediatric radiology consultants, independent of each other.
22. The Trust said on review of the CT report and the findings in the skeletal survey the radiologist reported ‘the possibility of non-accidental injury should be considered’. The Trust said the radiology reports are interpretative and not a definite diagnosis, and the findings were made based on available information at the time.
23. The Trust informed a social worker about the reports and arranged a multi-agency strategy meeting for 12 April.
24. The Trust said in its response dated 6 December that following the strategy meeting, social care felt further enquires and investigations were necessary to ensure the safety and wellbeing of Master N and his siblings. The multi-agency team concluded that Master N would be discharged to his maternal grandmother whilst these investigations were ongoing.
25. The Trust said a second skeletal survey was done on the 24 April, two weeks after the first, in line with standard practice. It said this was again reviewed independently by two radiologists. Their opinion was that there was evidence of healing fractures. This information was shared with social care as part of their ongoing enquires.
26. The Trust said the assessment for non-mobile babies with injuries, including bruises, burns and scalds should be subject to multi-agency enquiries to assess risk of harm.
27. The Trust said it followed protocol as agreed by the Bradford, Calderdale, Kirklees and Wakefield Safeguarding Children Partnerships.
28. The Royal College of Paediatrics and Child Health (RCPCH) guidance says ‘A full skeletal survey is recommended in all children less than two years of age where physical abuse is suspected’, and ‘Positive Skeletal Survey findings were also seen in 29% of infants aged less than one year with an unwitnessed head injury warranting child protection investigations’.
29. Our adviser reviewed the records including the skeletal surveys and images provided. They said there is evidence of metaphyseal corner fractures which are tiny breaks at the end of growing bones in the baseline first skeletal survey performed on 10 April.
30. Our adviser also saw fractures or breaks at the ends of certain growing bones, these are also known as corner fractures. These tiny fractures are found near the wrists on both arms (on the outer side of the forearm bones) and near the knee at the lower end of the thigh bone.
31. We understand, this led to a chain of events which must have been extremely traumatic for all the family. Based on the evidence and records, we found no indications of failings by the Trust in the diagnosis of the fractures on the 10 April. As such we will not be taking any further action.
32. Our adviser tells us when the second skeletal survey was done on the 24 April most of the tiny bone fractures seen earlier were no longer visible, except for the one in the left forearm bone. Any faint lines or dark areas that suggested a bone break on the first skeletal survey are no longer visible, and no new fractures were seen.
33. The adviser tells us the changes in the follow-up skeletal survey of the 24 April with regards to the fractures seen on the baseline skeletal survey of the 10 April could be described as healing.
34. The Trust did follow the correct procedures and processes in diagnosing the fractures, as such we find no indications of failings. This was a very difficult time for the family. We wish to assure them the Trust acted correctly based on the results of the X-rays.
35. We are deeply sorry to hear of the extremely difficult time that Mr N and his family suffered, and we wish Master N a full recovery.
36. We want to thank Mr N for bringing this complaint to us, and we wish Mr N and his family well for the future.