“very impressive”, and “a key expert” ([111]). The Judge rehearsed Mr Jayamohan’s evidence by selecting a number of key points; it is not necessary for me to reproduce the list in full for the purposes of our determination, but I reference nine of the points highlighted by the Judge: i) SGHs are “rare” in toddlers [94(c)]; the unchallenged evidence before the court was that this type of injury was generally seen after difficult vaginal deliveries associated with instrumentation. Mr Jayamohan had in fact told the court that “if this was to have occurred from a low level fall then it must be incredibly rare” (my emphasis by underlining); ii) It is “possible”, but it would be “unusual”, for a child to sustain a SGH, following the mother’s described mechanism of injury ([94](e)); iii) The progression of J’s symptoms after the incident was “unusual” ([94](d)); J should be considered on an “individualised” basis (ibid.); iv) The injury would be caused by a “shearing or sliding mechanism… a sliding motion rather than a straight impact” ([94](g)); v) After the SGH had been suffered, “the tissue [around the SGH] remained vulnerable to reinjury from normal handling” ([94(f)]); and “[r]einjury could not take place by the further significant force being inflicted but by the application of a lower force; this would include those seen in a domestic environment. However, the presentation would appear to be abusive” ([94](h)); vi) “An impact between the head and the side of the cot or on the music box in the cot could account for the June injuries” ([94](j)); (though Mr Twomey took us to the report of Mr Jayamohan in this regard wherein it had been said that it was “unlikely but possible” that a further impact in June in the cot may have set off further scalp and subgaleal collections); vii) The radiator “incident” (by which it is assumed that the expert and the Judge were referring to the final version of events given by the mother) was a “potential cause of the injury” ([94](l)); viii) “One possibility for J’s injuries could be a head injury inflicted on J when he was hit multiple times over a period of months… Another possibility was that there was an impact such as the one described by M in April that was followed by evolution of injuries caused by the redistribution of bleeding from the subgaleal haematoma” ([94](a)/(b)]); ix) The Judge reproduced an extract from the transcript of Mr Jayamohan’s contribution to the experts’ meeting; in this extract Mr Jayamohan is recorded to have accepted that he could not say that non-accidental injury was more likely than accidental injury; they would both be “unusual”
“This also raised the question of whether the radiator was hot when J fell against it and if it was, why M left him near that area or did not remove him quickly when he started to topple”
“[173] Of even more concern is that the picture of J’s injuries on 24 April does not fit with M’s description of what happened. It shows two vertical grazes present on the head. That does not fit with falling onto a radiator nor sliding down a radiator and/or a wall”
“[223] The photographic evidence of J did not fit her description of what happened on any basis”
“…tried to pull himself up on the left corner of the radiator. His legs then went wobbly and after losing his balance, he fell onto the side of the radiator. He then hit the same part of his head on the wall.... then he hit the carpeted floor.”
“… the medical evidence supported a view that the injuries could be the result of an accident and were evolving which was observed under the eyes of the doctors in hospital when there was no opportunity for J to be harmed by his parents”
“of even more concern…” in [173] and the expression in [223]: “The photographic evidence of J did not fit her description of what happened on any basis”
“… [t]he two vertical grazes present on the swelling combined with the description by M of how the fall happened make it difficult to see how that injury may have been caused by falling on the radiator”
“It is an elementary feature of a fair hearing that an adverse finding can only be made where the person in question knows of the allegation and the substance of the supporting evidence and has had a reasonable opportunity to respond.”
“A picture of J on 6 June clearly showed J with the subconjunctival haemorrhage. A clear picture on 19 May did not reveal anything. By May, the effect of the subgaleal haemorrhage was observed; if the eye was to follow the same course, the subconjunctival haemorrhage should also have been present by that time. It was not…”
“In the context of parents purchasing a helmet for J and being concerned for the safety of his head, it made no sense to put a hard object such as a music box in J’s cot”