New pathologist missed infant's multiple fractures

In his previous employment as a pathologist in Northern Ireland, the Republic's new Assistant State Pathologist was cleared of serious professional misconduct after he gave x-rays only a "cursory glance". His behaviour was described as"unprofessional", Emma Browne reports

The recently appointed Assistant State Pathologist, Dr Michael Curtis, failed to notice multiple fractures in the body of a 14 month old boy, David Briggs, during an autopsy in Northern Ireland in 2000. He also failed on two occasions to consider properly a cause of death according to two independent investigations.

A Department of Justice spokesperson said that Dr Michael Curtis was appointed after a public competition held by the Public Appointments Service. The spokesperson said that the "interview board was aware of the Briggs case and that Dr Curtis had been cleared of any wrongdoing by the General Medical Council, London".

Two weeks after the death of David Brigg's, his twin Samuel, was admitted to hospital with a fractured skull and other injuries that were later found to be as a result of physical abuse by the father. When David Brigg's x-rays were re-examined it was found that the child had multiple fractures that were missed in the first autopsy by Dr Curtis.

In January 2004 an investigation into the conduct of Dr Curtis was launched by the General Medical Council (GMC) in the United Kingdom (at the time of the incident he was assistant state pathologist in Northern Ireland). They cleared him of serious professional misconduct but concluded that his behaviour was unprofessional because of his failure to observe multiple healing rib fractures and his failure to "exercise reasonable skill and competence" in the first autopsy. These failures resulted in a need to exhume the body for a second post-mortem.

They also concluded that these failures showed his behaviour was "inappropriate and liable to bring the medical profession into disrepute". They found that he failed to interpret the full skeletal x-ray properly and failed to consider the possible causes of bruising on the head of the young boy.

David Briggs was admitted to hospital on 23 October 2000 and pronounced dead on arrival. When his twin was admitted with fractures on 5 November 2000, suspicions were raised about the death of David Briggs and a pediatric pathologist re-examined David Brigg's x-rays. They found that he had multiple rib fractures, a fracture of the left-wrist, plus a fresh fracture of the collarbone. These were all missed in the first autopsy.

The GMC Professional Conduct Committee heard evidence that in the first autopsy Dr Curtis relied on information from a consultant radiologist, relayed through a third party that the x-rays were "okay". The committee acknowledged that there were no formal protocols or systems for reporting on the results of x-rays at that time. Dr Curtis acknowledged to the committee that he had given them only a "cursory glance".

Once the fractures were spotted, David Brigg's body was exhumed and a second autopsy was conducted. Dr Curtis was assisted by two paediatric pathologists in this second autopsy. In both the first and second autopsy reports Dr Curtis was unable to ascertain the cause of death. Subsequently an independent pathologist Dr Jean Keelin reviewed the case and found a cause of death. She said that David Briggs died of a lack of oxygen. She told the GMC committee that "damage to the baby's heart, brain and lungs was evidence of a lack of oxygen caused by interference with his breathing". She went on,"We just can't write-off this sort of evidence of damage".

Dr Jean Keelin also said rib fractures on his body, missed by Dr Curtis at the initial post mortem, were inflicted with "considerable force" either through squeezing by someone with big hands, or by crushing against a hard surface. She said the infant had previously been subjected to serious assaults on more than one occasion.

A report commissioned by the State Pathologist of Northern Ireland and the Northern Ireland Office was also critical of Dr Curtis' lack of consideration of a cause of death.

The Milroy & Risden report said that the first pathology report should have "included more comment about the possible cause of death" and that "the presence of the scalp bruising should have raised the question of a potential homicide investigation". They said "the injuries were clearly non-accidental". This is at odds with the first autopsy report which did not regard the cause of death as suspicious.

The report recommended that a pediatric pathologist should have been directly involved in the first autopsy, and recommended that one be present at all infant autopsies. At the GMC hearing Dr Curtis insisted that even with hindsight he stood by his finding that the cause of death could not be determined.

Dr Curtis was appointed Assistant State Pathologist to the Republic of Ireland in November 2004. Village requested an interview with Dr Curtis but this was declined. We also offered to forward him this article through the Department of Justice but this could not be facilitated.

Geoffrey and Gwen Briggs had adopted the twin boys from Romania in 2000. Geoffrey Briggs initially denied causing the injury to Samuel Briggs but four days later admitted to a social worker and later police that he had lost control when the baby resisted his efforts to administer Calpol. He admitted hitting the boy and was sentenced to one year imprisonment for Grievous Bodily Harm. In relation to David Briggs there have been no charges but there is an ongoing criminal investigation.

The Police Service of Northern Ireland issued a statement saying: "A further police investigation was initiated in 2003 into the death of a 14 month old child in Portadown on the 23rd October 2000 as a result of further medical evidence. Two persons were interviewed about the death of the 14 month old child and have been released pending report to the DPP." The surviving twin, Samuel Briggs has since been adopted by another family.

The Craigavon and Banbridge Social Services were also heavily criticised at the time. They, as a trust, oversaw the adoption of the Romanian twins by Gwen and Geoffrey Briggs. In July 2000 the Briggs' brought the boys to live in Northern Ireland. As Romanian adoption is not recognised by the United Kingdom they had to wait a year until they could adopt them in Northern Ireland. Within four months of the twins arriving, one was dead and the other had been admitted to hospital with a fractured skull.

A Department of Health report in 2003 criticised the Craigavon and Banbridge Social Services. They said the inter-country adoption process was inadequate and the trust failed to monitor the wellbeing of the children properly, once they arrived in Northern Ireland. They recommended the need for better monitoring systems and a need to establish more effective communication. They said these issues must be addressed "to avoid similar tragic events in the future and to ensure that vulnerable children are safeguarded".

Claire McDonnell who worked for the trust was also the subject of a professional conduct hearing by the Nursing and Midwifery Council in relation to Briggs twins. In December 2004 the Nursing and Midwifery Council announced that "no action" was taken against Claire McDonnell.

The BBC programme Spotlight discovered in 2004 that the Romanian mother of the boys, a Mrs Filipache, had no knowledge about their adoption or what had happened to them. They boys had been taken from her care when the local child protection authorities became concerned about their living conditions. She and her seven children were sharing one room in a relative's house without running water or electricity. Their own home had collapsed in a storm the year before. Mrs Filipache recalled signing a form but believed it was to renounce government benefits for the boys. In fact she was signing a consent form for adoption. She was barely literate.

Under Romanian law at that time, international adoption was meant to be a last resort for children in care. Other possibilities like re-integration into the family, fostering or domestic adoption were to be considered first.

Yet the consent form was signed only a week after the emergency care order was implemented.

Officials in Romania say that the process was entirely legal and that the paperwork was signed in the presence of a public notary.

Romania banned international adoption in 2001 amid allegations of corruption in the system.