Salt poison child inquest halted

Published Thursday, 05 June 2014
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An inquest into how a four-year-old girl died from salt poisoning has dramatically halted after a judge said he "felt an offence may have been committed".

Coroner Jim Kitson said he was "duty bound" to halt the inquest into how Filipino girl Lindsey Angela Alvarez died and that as a result of the evidence he has heard this week, he will be filing a report to the Public Prosecution Service.

The judge's decision on Thursday came after he heard a doctor's evidence that Lindsey must have been "forced" to ingest more than seven and a half tea spoons of salt.

Giving evidence at the Coroners Court Inquest into the death of the child in August 2009, sodium expert and consultant paediatric pathologist Dr Duncan Coulthard described how the little girl had "extremely high sodium levels in her blood" when she was admitted to the Ulster Hospital.

"The only mechanism I believe that could have caused that was by ingesting an excess of salt and the only mechanism I can postulate was that that was forced upon her," declared Dr Coulthard.

He told Coroners lawyer David Sharpe: "I cannot accept the possibility that she took this voluntarily."

Severely autistic Lindsey was rushed to the Ulster Hospital suffering from breathing difficulties, vomiting and diarrhoea on 29 July, 2009 before being transferred to the Intensive Care Unit at the Children's Hospital where she tragically died from hypernatraemia as a result of salt poisoning on 4 August.

The inquest being conducted by Coroner Jim Kitson has already heard evidence that on the day she fell ill, Lindsey was being looked after by her uncle Michael Valderama at his flat at Ardara Mews in Dundonald when her mother Amelda Alvarez and aunt Mylin Valderama had gone to work as nurses at the nearby Ulster Hospital.

All three adults have denied giving the little girl either salt or a salty drink and there has also been evidence from pathologist Dr Peter Ingram that when he examined Lindsey's body, he found multiple rib fractures and finger-tip type bruises at the back of her neck as if she had been firmly grasped as well as bruising to her chest, arm and abdomen consistent with being "poked" by a finger.

There has also been evidence that Michael Valderama told police that Lindsey's father Angelito, also known as Jojo and who has returned to the Philippines, beat both his only daughter and his wife.

On 29 July, the first call to emergency services came at 1.55pm and on Thursday, Dr Duncan opined that the salt in Lindsey's system was given to her within four hours of that call.

He told the court he had conducted a "horrible" experiment on himself by forcing himself to swallow just over six grams of salt and that testing of his blood and urine showed that the sodium levels reached their peak after 90 minutes, adding that children process salt " extremely quickly" so it was his opinion that four hours was the maximum time between admission and her being given the salt to eat.

Dr Coulthard said that in comparison with the 27-30 grams given to Lindsey, which he said was an "underestimation" and would be equivalent to the salt in around ten Big Mac burgers, taking it was "really, really horrific and makes you feel violently ill."

A child's normal salt intake would be around three to four grams in a day, he told the court.

Dr Coulthard told Mr Sharpe that he and another professor, who has since died, searched through "worldwide literature" into salt poisoning and did not find any cases of salt being ingested voluntarily by a child.

A normal sodium plasma level is around 140 but Lindsey's plasma sodium level was measured at 180, the court heard with Dr Coulthard commenting that that was "unbelievably high".

"I think people need to understand that this isn't just a bit high," said the doctor, adding that even with the "excellent care" Lindsey received in the Ulster, her chances of survival were still only "50/50."

The inquest has also heard evidence that Lindsey sustained eight fractured ribs when she fell down the stairs at her uncle's flat at Ardara Mews in Dundonald a week before she fell ill and that in 2005 when she was around 14 months old, she was put on the child protection list when she suffered a broken ankle.

Bone expert Professor Archibald Malcolm said the rib fractures were consistent with her having fallen down the stairs around two weeks before she died.

However, the previous witness, consultant paediatrician Dr Dewi Evans said they were equally consistent with "deliberate impact trauma" such as her having "been thrown down the stairs".

He said that despite her severe autism, which caused massive communication problems and left her with a very "blank expressionless face," Lindsey would still have had "self preservation" and that as such, he would have expected to have found other injuries such as a broken wrist from the fall so "concerns regarding these injuries remains."

Dr Evans added, however, that given the evidence of bruises to her arms, neck and abdomen, while the fractures were "worrying," he could not rule out that the fall was an accident or that "there was more to it than that".

In relation to her fractured ankle, it apparently happened when her father Angelito, was changing her nappy and Lindsey " twisted" from her back to her front.

Dr Evans said however her fracture had been transverse which would suggest a blow or force being applied to her leg, comparing it with a fracture a footballer might sustain in a tackle, rather than a spiral fracture which would result from a twisting force so the apparent explanation was "suspicious".

Adjourning the inquest until the outcome of any PPS investigations, Coroner Kitson apologised to witnesses who were yet to be heard by the inquest.

The judge's dramatic step came moments after the arrival in the court of the uncle's solicitor Stephen Tumelty.

Afterwards, Mr Valderama left the court building alone, speaking intently on a mobile phone as he passed waiting media.

© UTV News
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