A CHILD spends five weeks in hospital with signs of 20 cigarette burns on her body. A health board is told this child steals lunches and falls asleep in school and that she leaves her home at night, clad in a blanket, to steal food.
Her hospitalisation gives rise to 20 months of substantial health board involvement with her family.
In spite of all this, her sister, Kelly Fitzgerald, returns from England, is mistreated and dies five months later in a London hospital. There is no effective intervention in her case by the health board concerned, the Western Health Board.
It is hard to imagine a worse failure on the part of the child protection system than this.
"There was no effective case management plan and the organisation and operation of case conferences was unsatisfactory in many respects", says an extract from the report.
The inquiry chairman, Mr Owen Keenan of Barnardos, stressed yesterday that the team was impressed with the calibre of the health board staff. Criticisms were directed at failures of the systems employed to protect children, he said.
What is to be done about this failure and who is to do it? First we need to see the full report and the former Minister of State, Mr Terry Leyden, has suggested it be placed on the record of the Dail to avoid libel problems. Then we may be able to establish what needs to be done.
But who is to do it? Hardly the health board which stands condemned of this catalogue of failure. The next move is up to Mr Michael Noonan and Mr Austin Currie.
They have hardly covered themselves in glory apparently they have not even seen a copy of the report but they are all we have got.