Coroner uneasy over little girl's injuries after inquest fails to establish how she died from salt poisoning
It has proven impossible to establish the circumstances in which an autistic girl from Dundonald ingested a fatal quantity of salt, an inquest has heard.
Lindsey Angela Alvarez (4) passed away at the Royal Belfast Hospital for Sick Children on August 4, 2009, just a few weeks before her fifth birthday.
At Belfast Coroner's Court yesterday, senior coroner John Leckey said that while a series of internal and external injuries she had also suffered, including fractured ribs and fingertip-type bruising, did not cause or contribute to her death, he remained concerned by them.
Mr Leckey added: "The findings of the pathologist would suggest to me that Lindsey had been the subject of a criminal assault or assaults. To date the perpetrator has not been identified."
The Filipina girl had been on the Child Protection Register at one stage, but was no longer listed at the time of her death.
She is said to have fallen down three stairs on July 25, 2009, while in the care of her uncle Michael Valderama, suffering a bruised temple.
On July 30, while again being looked after by her uncle, she suffered two episodes of diarrhoea. That afternoon, when her aunt returned, Lindsey was found to be "barely responsive, cold and clammy".
The little girl, who as well as autism suffered from learning difficulties, was taken to A&E at the Ulster Hospital and then transferred to the paediatric intensive care unit of the Royal, where it was noted that she had bruising on her face, chest and arm.
Blood tests revealed she was suffering from severe hypernatraemia, and despite the salt poisoning being corrected she died on August 4. The inquest into her death was stopped in dramatic fashion last year when coroner Jim Kitson said he felt a criminal offence had been committed.
He referred the case back to the Public Prosecution Service (PPS) after an expert witness expressed doubts that the child could have voluntarily consumed the volume of salt - around seven teaspoons - found in her body.
But last month it emerged that the PPS had ruled out a prosecution, so yesterday Mr Leckey brought the inquest to a close so that Lindsey's death could be registered.
He recorded the cause as cerebral hypoxia due to cerebral oedema (brain swelling), hypernatraemia and excess ingestion of salt.
The inquest closing does not stop any future criminal proceedings if new evidence emerges.
Belfast-based chemical pathologist Professor Ian Young told the court the medical experts involved in the case were of the consensus the salt that killed Lindsey was probably administered in a liquid solution.
In response to a question from Mr Valderama's solicitor, Stephen Tumelty, Professor Michael Fitzgerald, an expert in child and adolescent psychiatry at Trinity College Dublin, confirmed abnormal sensory issues meant Lindsey could have consumed the salt and not found it distasteful or unpleasant.
Professor Fitzgerald also told the court that Lindsey's autism meant she had a very high pain threshold and could have had broken bones but not complained.
Mr Leckey noted that investigations had failed to establish where the sodium found in the child's system came from.
"It has proved impossible to ascertain the circumstances in which Lindsey ingested the salt," he added.
In his findings the senior coroner also listed the injuries which a pathologist said Lindsey had suffered. They included:
- Eight fractured ribs, which could have been the result of non-accidental trauma to the chest.
- A bruise on the right side of her neck probably caused by it having been grasped firmly, and bruising on the right arm consistent with it having been gripped firmly.
- Chest and abdominal bruising consistent with a non-accidental injury and also consistent with Lindsey having been poked firmly with a fingertip.
- Bruises to the back of her scalp typical of fingertip-type bruises seen in cases of non-accidental injury.
- Other bruising that could have been a result of minor knocks or falls.
Lindsey's mother, Amelda Alvarez, who works as a nurse, has lost two of her children in tragic circumstances.
In 2012, her son Rham (2) was killed in Dundonald when a parked car without the handbrake on careered down a hill and into his buggy.