Sadder, But Wiser--Part IV

Cover-Ups Not A Legitimate Option

Breaking Silence: The Kahui Case is considerably more than a whodunnit tell-all.  Author, Ian Wishart has endeavoured to put the death of the Kahui twins in a broader context--in particular, the matrix of public paediatric health services.  What we had forgotten before Wishart reminded us is that the Kahui twins, Chris and Cru were still four weeks premature when they died. These babies were at risk from the day they were discharged.


Macsyna King's babies were born in March 2006, three months premature.  That they were twins made their survival all the more marginal.  Macsyna was soon discharged from hospital whilst the twins were kept in the neo-natal unit at Middlemore Hospital where they were cared for.  King and Kahui visited and began distance-care for their children as best they could.  The twins were discharged early May, two weeks before the fatal injuries were inflicted.  Even if the twins had been discharged to a devoted, monogamous, nuclear-family-couple, living in a stable family, with no alcohol abuse or degenerate whanauism they would still have been highly at risk.  They would have required far more care, attention, devotion, observation than normal, full-term babies, let alone twins.  Anyone who has raised multiple children, including twins, will know the truth of this. 

It is undeniable that the Kahui twins were vulnerable and at risk--through no fault of their parents.  Now this in no way excuses any subsequent lack of care, nor does it justify any physical abuse.  But it is still worthwhile to understand how public health policy is currently applied to such cases in New Zealand.  Hindsight suggests that these twins should likely never have been discharged so early. 

Well, some may say, if the twins were OK why oughtn't they be discharged?  Plenty premature babies are.  Wishart does excellent work explaining the extent of the risks.  But we also need to be clear: the public health system did not just let the twins go.  A community care programme swung into effect.  The King-Kahui household did have plenty of support.  One of the intriguing things is that by all accounts the twins appeared to be doing well.

One of the facts established by the post-mortems was that the twins had broken ribs--older injuries, already healing.  The inference was immediately made in the media/public that King had been responsible for this "abuse". It turns out, however, that this is a red herring. 

 It wasn't just nurses who failed to detect even one sign of abuse or the historical fractures and head injuries.  At one point--the hospital confirms it was mid May and Macsyna thought it was early June--the twins were hospitalised with bronchiolitis. They were under specialised paediatric care for two nights and two days, and Macsyna stayed with the twins in hospital.  Not one Middlemore paediatrician or nurse reported finding any hint of the injuries the forensic experts insist were already there.

In truth, there were "five nursing visits, two social worker visits and three other arranged visits, and in total 12 interactions or attempted interactions by phone and with the family,"  in the space of just four weeks.  Medical professional and social workers were crawling all over the twins, and no one saw anything wrong.

On June 7, 2006, just a week before being admitted to hospital with fatal brain damage, family GP Dr Gopinth Nayar gave baby Cru a "thorough" check over.  A number of Cru's ribs were fractured, but Nayar detected nothing--no pain response, no sign of abuse.  Ian Wishart, Breaking Silence: The Kahui Case (Kaukapakapa: Howling At The Moon Publishing, 2011), p.111.

 That's curious.  No signs of pain or abuse.  Whence the broken ribs: it can occur via ordinary handling--and is not uncommon in babies born prematurely.  Moreover, we know that at least Cru was subjected to CPR in the hospital before release.  That may have caused broken ribs in one so tiny and vulnerable. 

And then there are the traumatic head injuries--historical injuries, inflicted allegedly days before the actual death of the twins (raising again the spectre of the an evil mother secretly, systematically smashing the heads of her twins over a period of four weeks).  Wishart makes the following, startling, albeit puzzling revelation:

The problem at a forensic level is that when the actual post-mortem was performed, none of the skull fractures was found to exist.  The one at the rear of Chris's head appears to have been a natural deformity in the skull.  Nor did the autopsy find any evidence of a "high right parietal fracture".

Adding corroboration to this, radiologist Sally Vogel conceded under cross-examination that she could find no evidence of any soft-tissue swelling over the supposed fracture sites--no bumps on the head. There was indeed a bruise on the back of Cru's head, so he'd suffered some damage anywhere up to a week or two prior to admission.  The bruise did not match any suspected fracture site.  So skull fractures?  They couldn't find them.  Breaking Silence, p.161. (Emphasis, ours)

Yet both babies died of severe brain damage.  And the real cause of that brain damage does not appear to be striking or physical impacts, but the breath holding or apnoea (similar to the effects of a stroke) that followed whatever impacts there were on that fateful Monday night.

Another curiosity is testamentary evidence that baby Cru suffered an apnoea attack while still in hospital.  Apnoea attacks where babies stop breathing and need to be revived are no uncommon in premature cases.  In fact, it occurs in 85% of premature babies born six weeks premature or more.  So, it would be "normal" for at least one of the twins, if not both, to have had at least one apnoea attack whilst in hospital.

Macsyna King was told by hospital staff (confirmed by Chris Kahui and an independent witness) that Cru had suffered an apnoea attack and he has been subjected to CPR to revive him.  It was apparently touch and go.  This would mean that at least Cru had increased risk and vulnerability when discharged.  Normally, monitoring equipment and breathing equipment would have been supplied.  None was.  In fact, there are no hospital records of any apnoea attacks upon the twins whatsoever.  Curious. 

We can only speculate as to why.  Wishart speculates that it may have been an ex-post cover-up on the part of the hospital.  If Cru suffered an apnoea attack requiring CPR--and that attack nearly killed him--whilst in hospital--and no special care and equipment was deployed after his release that raises lots of questions about hospital competence in this case.  But--and this is material--it would have put an already vulnerable five week prem baby in an even more vulnerable and risky space. (Remember, the damage to the brains of the twins was caused by apnoea--some time on that Monday night, the twins stopped breathing for a period, during which subsequently fatal brain damage occurred.)

Finally, Wishart raises another systemic issue:  whilst still in hospital, the twins were subjected to the "routine" immunisations before they were sent out into the big, bright world.  He suggests it is highly likely the twins were suffering from scurvy--caused by vitamin C deficiency--and which only now is being recognized as afflicting infants.

Scurvy weakens the wall of blood vessels, making them much more prone to haemorrhaging.  The weakness of the capillaries "is the result of elevated blood histamine levels, which occur with even mild ascorbate (vitamin C) depletion".  Those raised blood histamine levels can ultimately cause both retinal and subdural haemorrhages, as well as general bruising--all classic signs of abuse.  Breaking Silence, p.246. 

Immunisations increase the histamine levels still further, which can cause much more damage.  Wishart reviews international evidence of scurvy, its effects, and the likely damage of immunisations when administered to a scurvy-afflicted infant.  In New Zealand paediatric public health policy, immunisations are standard; scurvy is ignored, and vitamin C deficiency is not on the radar screen.  As so often is the case, the preventative (immunisations to vulnerable, still developing, premature babies) appears to be much worse than the ills it is designed to prevent.

These systemic public issues are startling--and Wishart has done us a great service to raise them. 

All-in-all it implies that Chris and Cru Kahui were far more at risk when discharged than anyone--including the health professionals--realised.  But how many more children are being exposed to the same risks?  These are important questions, needing to be asked and answered--not defensively, but carefully, with open minds.  The issues are too important not to.

Let's not forget--the mob wanted this book banned.  Spare us.