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Expert says Lola’s eye injuries suggest abusive head trauma

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LOLA’S eye injuries are indicative of abusive head trauma, the first medical expert to take to the witness stand told Swansea Crown Court on Friday (Mar 10).

Dr Ian Simmons, Consultant paediatric ophthalmologist gave his opinion on the findings in his report into the retina injuries sustained by the toddler.

Dr Simmons has been an expert in the field since 1999 and has contributed to major studies and literature looking into retinal findings in non-abusive head trauma and abusive head trauma.

Including reviewing and contributing to a review into differential retinal injuries in abusive vs non-abusive head traumas in September 2020.

Swansea Crown Court heard how Lola had multiple haemorrhages in both her right and left eye, which also was evident in all four quadrants; during medical examinations, eyes are split into quarters and referred to as quadrants to locate any significant anomaly.

The injuries were detected through a range of diagnostic methods, including visual, 2d scans, retcams (3d) and the findings during the course of a post-mortem.

These included two large macular haemorrhages to the right eye which were present in all four quadrants, along with multiple other haemorrhages, noted there were too numerous to count.

The court heard how Lola’s left eye had a massive dic haemorrages along with others in all four quardants and macular changes due to retinal splitting. There was also bleeding to the oribital and optical nerve in both eyes.

Dr Simmons went on to say how bi-lateral retinal heamoraghes; those affecting both eyes, are highly indicative of an abusive head trauma as opposed to accidental.

He went on to say that injuries of the retina, such as those sustained by Lola are usually present in children who have sustained a very significant crush injury or a fall from a height such as a house window.

The court heard how the presence of macular folds is more prevalent in an abusive head trauma injury by the tenfold.

Dr Simmons confirmed that before compile his expert opinion report he was privy to reports from all medical professionals who treated Lola, including reports and scans, the autopsy report, police statements and photographs of the family home namely the stairs the defence claim Lola fell down.

The court heard that Dr Simmons bore no knowledge of a child presenting with optical nerve sheath haemorrhages in both eyes ever being presented in an accidental head trauma.

The court heard how Dr Simmons had gone through an extensive exclusion procedure and ruled out any underlying diseases, or anything within the statements from the police that would suggest anything other than abusive head trauma would cause the injuries.

Bevan’s Barrister, John Hipkins KC brought to the court’s attention a case study from 2013, by Dr Adams, another paediatric ophthalmologist, in which a child had a fatal fall down 10 steps, with multiple impacts and noted that the injuries received by that child were similar to that of Lola’s.

He explained that this was a witnessed accidental fall and the injuries were received as a result of accidental head trauma.

Dr Simmons went on to clarify that although those injuries bore a ‘striking resemblance’ to this case, that child did not present with peri-macular folding and sheath haemorrhages that Lola did, and those indicate it is more likely in this case as a result of an abusive head trauma.

In his report Dr Simmons said: “With a combination of extensive bilateral retinal bleeding in all four quadrants affecting multiple layers in both eyes with possible retinal splitting along with evidence of left per-macular retinal fold and presence of bilateral optic nerve sheath haemorrhages, that combination pointed towards abusive head trauma rather than an accidental fall down the stairs.

“Highly unlikely the above combination would have been caused by falling down 10 carpeted stairs.”

Dr Simmons suggested that based on the other injuries Lola had and reading the medical reports it points towards abusive head injury from that such as violent shaking with a possible form of impact.

John Hipkin KC, went on to question Dr Simmon on the language used in his report stating it was all based on medical science which meant they were left to deal with “likelihoods instead of certainties”.

Dr Simmons explained that medical science is not definitive, but certain retinal injuries are highly suggestive towards abusive head trauma based on medical evidence from data collection.

Mr Hipkin KC went on to ask if Dr Simmon had been given Bevan’s statement of his account of the accident, which he confirmed was received and had used that evidence to make his conclusion.

Suggesting that shaking could have been part of Bevans attempts to wake the tot.

However Mr Hipkin went on to say that Bevan’s statement was not included on Dr Simmons summary of evidence documents used to support his claims.

Dr Simmons could not recall whether he had simply forgotten to include them or whether they were together with another set of reports in a bundle which is included on the summary of evidence on the report.

James’ Barrister Mr Elias did not cross examine the witness.

The next medical expert witness is due to take the stand on Monday.

The case was adjourned and will continue on Monday, March 13 at 10am.

Health

New X-ray equipment plan at Tenby Cottage Hospital revealed

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X-RAY services at Tenby Cottage Hospital are to receive a major boost thanks to an investment of £625,000 in brand new equipment which is being installed at the Hywel Dda Health Board-run site over the next few weeks.

The equipment, funded by Welsh Government, will allow the unit not only to provide the highest quality images but will also mean patients with reduced mobility or advanced clinical needs can be more easily accommodated.

However, in order to install the new equipment, x-ray services will be temporarily unavailable in Tenby Cottage Hospital until Friday, 19April 2024.

Over the next few weeks, imaging for GP patients will be provided on an appointment only basis at South Pembrokeshire Hospital in Pembroke Dock between 9-5pm.

Patients attending the Minor Injuries walk-in centre can still attend Tenby Cottage Hospital but may be sent to Withybush if an x-ray is required. Alternatively, patients can choose to attend Withybush Emergency Department directly.

John Evans, Pembrokeshire County Director for Hywel Dda said: “We are delighted that Tenby Cottage Hospital will be receiving brand new and up to date x-ray equipment thanks to this investment from Welsh Government.

“We apologise for any inconvenience caused over the short period of time while the equipment is being installed but look forward to providing an improved level of care for Tenby community patients into the future.”

Patients needing further help or information should contact the radiology departments at Withybush Hospital on 01437 773385 or South Pembrokeshire Hospital on 01437 774018.

The health board is reminding people not to attend busy A&E departments unless they have a critical, life-threatening emergency and asking people to choose their healthcare services very carefully, so that only people with urgent or emergency care needs are being seen in A&E. 

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Farming

Police warn of disruption to traffic as farmers protests take place

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FARMERS protests are taking place in Aberystwyth and Carmarthen today (Feb 22.)

The police took to Facebook on Thursday morning saying: “We are aware of potential disruption to traffic in Carmarthen and Aberystwyth town centres from midday today.

“The traffic network in and out of the towns may also be affected.

“If you are planning on travelling in those areas today, please consider changing your route or journey time to avoid delays.

“We will update when we have further information.”

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Health

NHS facing unprecedented winter pressures amid record demand

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THE NHS in Wales has been facing significant challenges this winter, with an exceptionally high number of emergency calls and delays that have put immense pressure on its staff and resources, according to the latest activity and performance statistics.

In January, the ambulance service received 5,009 red (life-threatening) calls, accounting for 13.9% of all calls. Despite a slight decrease from December, with an average of 162 life-threatening calls per day, this figure remains the third highest on record. The response times for these urgent calls have also been under scrutiny, with 48.8% of red calls receiving an emergency response within eight minutes, marking the second highest achievement for this metric. The average response time for these calls was 8 minutes and 11 seconds.

The performance data also revealed that approximately 27,000 hours were lost due to handover delays at hospitals, highlighting the systemic pressures faced by the health service. Despite these challenges, nearly all health boards came close to meeting the target for 97% of patient pathways waiting less than two years by 2024, missing it by a mere 0.03%.

Nesta Lloyd-Jones, Assistant Director of the Welsh NHS Confederation, commented on the impact of the winter pressures and the exceptional demand on NHS services. “The monumental efforts of our staff have led to some improvements, such as a decrease in the number of people waiting the longest for treatment in December. However, the progress is threatened by the junior doctor strike action in January and February, which has led to a significant number of planned care procedures being postponed.”

Lloyd-Jones stressed the need for comprehensive planning and significant investment in NHS infrastructure and social care to ensure the health service can continue to improve and meet the demands placed upon it. “Good planning alone is not enough. Without significant capital investment and a whole-nation approach to health and wellbeing, alongside substantial changes to social care funding and provision, the progress of NHS leaders will be limited.”

The Welsh NHS Confederation, which represents the seven local health boards, three NHS trusts, and other health organisations in Wales, has been vocal about the challenges faced by the NHS and the need for strategic investment and support to navigate through these difficult times.

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