Ethan Ives-Griffiths murder trial day 5 at Mold Crown Court
Michael Ives, 47, and Kerry Ives, 46, from Garden City, stand accused of murdering Ethan Ives-Griffiths, who died on August 16, 2021.
They have also been charged with: Causing or allowing a child to suffer serious physical harm, and Causing the assault / ill treatment / neglect / abandonment of a child to cause unnecessary suffering / injury.
Shannon Ives, 28, Ethan's mother, also standing trial, has been charged with: Causing or allowing a child to suffer serious physical harm, and Causing the assault / ill treatment / neglect / abandonment of a child to cause unnecessary suffering / injury.
At Mold Crown Court on Thursday (June 12), the court heard evidence from medical experts.
Dr Daniel Du Plessis, a consultant neuropathologist for over 22 years and specialises in unnatural trauma to the brain and spinal cord, was first to be called to the witness stand.
Dr Du Plessis told the court that Ethan suffered a Hypoxic Ischemic brain injury – a technical term no blood or oxygen getting to the brain.
He stated that Ethan had also suffered a subdural bleed and that he could rule out any natural causes in this case, and that he can be "certain" Ethan suffered a "traumatic subdural bleed".
Dr Du Plessis said that the "traumatic subdural bleed" is consistent with being subject to "some physical force or rapid movement, including twisting or forwards or backwards movement."
He added that Ethan's scans showed fresh bleeds on the brain that were 48 hours or less in age, stating that he felt the bleed occurred on August 14, 2021.
Dr Du Plessis stated that Ethan also suffered a Sub arachnoid haemorrhage, "one of the most painful things" a conscious person can experience.
Dr Du Plessis said that if Ethan had suffered this injury when conscious he would have been "screaming his head off".
He also told the court that Ethan suffered a spinal subdural haemorrhage, which "suggests a non-accidental injury".
He added it is an 'extremely valuable and reliable feature in non-accidental trauma in young children'. Dr Du Plessis said that a "non-traumatic" cause had been ruled out in this case.
"This is definite evidence of a major traumatic event," he added.
Dr Du Plessis referred to the bilateral retinal bleeding suffered by Ethan, in addition to the subdural bleed and swollen brain, stating that those three injuries are often referred to "the triad" in young children.
He said that if a "young child presents with 'triad' you should strongly consider non-accidental".
Ethan's case 'can be classed as an extreme example of triad injuries," he added
When asked about the level of force needed to cause the injuries suffered by Ethan, Dr Du Plessis said it would be "severe".
He said the best example is that it would "involve an act that would horrify a bystander".
Dr Du Plessis said that it would require "vigorous shaking" in addition with a head having an impact with an object, examples listed by Dr Du Plessis included a "wall, cushion or sofa".
Concluding, Dr Du Plessis said that "a traumatic head injury" was the cause of Ethan's collapse on August 14, the findings were consistent of a "non-accidental" injury and that there was "no plausible" evidence of an accidental head injury.
David Elias KC, defending Michael Ives, stated that Dr Du Plessis said it was 'most likely' Ethan's collapse was "within minutes" of suffering the injury, but argued that he could not exclude a longer timeframe, which Dr Du Plessis agreed with.
Mr Elias also said the court "must be careful" when thinking of how Ethan presented, referring to the sub arachnoid haemorrhage and spinal nerve root bleeds being "secondary" injuries.
Discussing Ethan's high sodium and the possibility of thrombosis, Dr Du Plessis said that thrombosis "didn't occur" and even if it did, it "wouldn't have explained subdural bleeding".
Dr Du Plessis said that he had carefully looked at the veins and found no evidence of any clots.
Owen Edwards KC, defence for Kerry Ives, asked whether a "single forceful blow with the front or back of an adult hand with resulting pivot of head" could cause these injuries, Dr Du Plessis said he "couldn't totally discount it", but was "highly sceptical", stating a fist would be "more plausible".
Mr Edwards asked whether a child's head hitting a sofa straight after could cause the injuries, Dr Du Plessis said it would "amplify the force" and that it could "possibly" cause the injuries and cause a collapse.
The court also heard evidence from Dr Malcolm Coulthard, a paediatric nephrologist, who specialises in looking at kidney related matters.
Dr Coulthard said that Ethan was "severely dehydrated" which was the cause of hypernatremia (high sodium levels).
Dr Coulthard stated that the levels of dehydration is often measured in a percentage loss in bodyweight.
Someone who is "thirsty for a drink" would be around one or two percent, says Dr Coulthard.
Dr Coulthard went on to say that "anything above 15 percent is life threatening" before telling the court Ethan was approximately 20% on August 14, and had lost around a fifth of his body weight in water.
Ethan's level of dehydration was compatible with having not drunk properly for several days, according to Dr Coulthard and that it would have been clear he required "urgent medical care".
Regarding Ethan's sodium levels, Dr Coulthard said that the normal person's level would be between 135-145 and that it is "key" to keep it in that range. Anything outside of range is "abnormal", says Dr Coulthard.
Dr Coulthard tells the court that Ethan's sodium levels were 180, "way, way, way above the top level of range."
"You would never see a child in your professional life time with sodium that high," said Dr Coulthard.
Referring to CCTV of Ethan on the trampoline from August 4, Dr Coulthard said that Ethan had shown signs of "neurological regression" as he was carried and "barely able to stand", showing "no interest in standing up".
Dr Coulthard said Ethan was 'bounced like a rag doll' on the trampoline, before being carried away by one arm in a 'bizarre way' by Michael Ives "hanging like a rag doll'.
Dr Coulthard added that there were "descriptions of him drinking and eating normally" from the defendants, which he claimed was "not possible".
When asked about the level of neglect towards Ethan, Dr Coulthard said it was "difficult to see how you could neglect a toddler worse than this".
Dr Coulthard said Ethan's weight loss and dehydration was "staggering" and that it couldn't have happened over three days, stating that "for some time this little boy could've had no food or drink".
Mr Edwards asked Dr Coulthard to confirm that Ethan was "clearly" unwell in the lead up to his death and that a brain injury had had an effect on him, which Dr Coulthard agreed.
Dr Coulthard added that although it was his diagnosis that Ethan wasn't wanting to eat or drink, he would expect Ethan's carers to "have concerns" over a toddler not wanting to eat or drink.
The trial continues.
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