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England and Wales High Court (Administrative Court) Decisions |
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You are here: BAILII >> Databases >> England and Wales High Court (Administrative Court) Decisions >> A, R (on the application of) v Liverpool City Council [2007] EWHC 1477 (Admin) (26 June 2007) URL: http://www.bailii.org/ew/cases/EWHC/Admin/2007/1477.html Cite as: [2007] EWHC 1477 (Admin) |
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QUEEN'S BENCH DIVSION
ADMINISTRATIVE COURT
B e f o r e :
____________________
THE QUEEN ON THE APPLICATION OF A | Claimant | |
v | ||
LIVERPOOL CITY COUNCIL | Defendant |
Mr Hilton Harrop-Griffiths (instructed by the Solicitor to Liverpool City Council) for the
Defendant
____________________
Computer-Aided Transcript of the Stenograph Notes of
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Mr Justice Walker :
Introduction
A Note of Caution
History of Events
5. An initial assessment of the claimant's age was made by two of the defendant's social workers on 5 January 2006. They completed an "Age Assessment" form, which recorded that the claimant's asserted date of birth was 1 January 1992. In the form they noted that no medical opinion had been sought. Their analysis was as follows:
"Initially [A] appeared youthful looking. [A] showed some signs of ageing, visible lines on the face and protruding Adam's apple. [A] was very articulate in his communication, [A] was relaxed confident during the interview. [A] showed no emotions when talking about his separation from his family, showing maturity in being able to control his emotions. [A] asked if he could be put with a family, as he may not find his own. [A] seemed to be aware of what is on offer in the UK for people under the age of 16 yrs. [A] stated his father had his birth certificate but the school told him his date of birth. [A] stated he was told his date of birth when he left six months ago.
Colleague and myself felt that [A] was very honest when explaining his journey to the U.K. [A] did not remember any problems leading up to their escape from Afghanistan but stated his Mother told him his Father had a fight.
[A] was asked how he felt he would cope living independently,
[A] stated he felt he would have no problems taking care of himself. [A] seemed very independent for a person who had never lived alone or helped around the house while living at home. [A] showed maturity in his ability to interact with adults.
[A] is considered to be a minor but over the age of 16 yrs. [A] will be supported by social services under section 17 of the Children Act 1989."
"Client history and examination
[A] was born at home in the Ghazni province of Afghanistan. His declared date of birth was not employed in the following age estimation. [A] did not recall any serious heath problems during his early life; he has had no chronic disease, trauma or surgery that may have affected his physical growth or maturity. He does not smoke tobacco or drink alcohol. He has had no teeth extracted but has some pain from several teeth. He takes no long-term medication. There is no evident history of malnutrition or food shortage. He attended formal schooling for between 3 and 4 years. He arrived in the United Kingdom in January 2006; he is not independent or self-caring and is currently cared for by Social Services. He has a younger brother aged 9 or 10 years of age. He has never known the age of his parents. An estimate of the mid-parental centile was in the region of 175 cms.
[A] is in good physical health at present. He is tall and slim. He is not anaemic or jaundiced. [A] has a height of 170 cms and shows no dysmorphic features, nutritional disorder or spinal anomaly. His mid upper arm circumferences is 22.6cms, his triceps skin fold thickness 2.6 mm. He shows no obvious signs of early aging in the skin around either the eyes or the hands although there is solar damage evident in these areas of skin. The client is sexually mature and Tanner stage 4/5 using this scoring system. On examining his mouth he has no erupted wisdom teeth (permanent third molars). There is no molar wear evident on the upper and lower jaws; there are several cavities as described. There is no gum inflammation or damage evident to my examination. There is no evidence of surgery. The morphology of this client's teeth and gums was carefully documented and compared with reference charts. His dietary history and socioeconomic status were taken into account in the estimation of his dental condition.
Age assessment of this client
The physical measures of this client including his height, skin fold thickness, body mass index, the skin signs seen in young adults and his dental examination today were consistent with a chronological age of 14 years when compared with published measures appropriate for adolescents and young adults. The narrative history provided does not provide any material to contradict this estimate or support another. The client has a number of skin changes that are deceptive, suggesting he is older, but in my opinion these are not linked to his
chronological age. These observations are supported by the non-objective assessment of the psychological maturity of this client during the interview, particularly in his interactions with myself and other staff during the appointment; the client behaves like a young adolescent. The physical measures have a published error of 2 years: more narrow error margin is probably not possible.
Further possible steps for age assessment
These specific measures of age may be extended if required by repeated measures over time (to estimate any height and weight velocity). Radiographs of the skull may aid the estimate, although dental aging techniques have an error of 2 years in this age group. Please contact me should there be an indication that these are required. Normal values for such measures are not available for central Asian populations, but are probably not significantly different from those employed in the UK. Use of any non-medical radiographs is not recommended under the current Royal College guidelines.
How does this report compare with others I have prepared?
In 2005 approximately 500 clients were seen for age assessment, referred from a range of sources. My age estimations for this group demonstrated 55% to be less than 18 years, and 12% to be 16 years or less in age.
How might this assessment be compared with another?
This holistic report of [A] is based on a number of objective, quantified forensic measurements, carefully collected and compared with the appropriate population data sets.. ."
7. At this point reference was made by Dr Michie to notes 2 and 3 to his first report. Note 2 was headed "Background to Age Assessment techniques: Evidence:", and cited various publications. Note 3 was headed "Dental Age Assessment: Evidence:", and gave four citations. The third of these was:
"Mincer HH, Harris EF, Berryman HE. The ABFO Study of Third Molar Development and its Use as an Estimator of Chronological Age. (JForenSci 1993; 38: 379-390)''
This paper will be referred to in this judgment as "the ABFO Study"
"Each measurement has an error; the final error is calculated on the basis of error propagation.. ."
Conclusions
Following an interview and an initial examination using recognised, validated, published and logical methods of measurement [reference was again made to notes 2 and 3] it is my independent opinion that [A] age is consistent with an age of 14 years. Please contact me should further details be required, if the authenticity of this report needs to be checked or further reference material would be contributory."
"I have seen a number of similar reports complied by DR. MICHIE. In some, though not here, he states, correctly, that dental methods of age assessment are the most accurate in the age range concerned.
He also sees fit, though a purely medical man, to comment on wholly dental matters, as he does in this case. His dental "findings"as stated fall under three headings:
A) MEANINGLESS to me as "The morphologyof teeth and gums.." and "His dietary history..".
B) IRRELEVANT as "no molar wear" and "no evidence of surgery".
c) NONSENSE-
1 "No erupted wisdom teeth". There were three -see below
2 "no gum inflammation". There was marked chronic redness, swelling and recession of the gum around the lower front teeth -see below.
DR MICHIE obviously had no idea what he was looking at and his conclusions are therefore wholly flawed in my opinion."
"[A] possessed thirty-one permanent teeth, or parts of them. Most were fairly healthy but three, the first molars at upper left and lower left and right, were very severely decayed to the point where there were only fragments of the roots left -these were easily visible. In all three areas the "gaps" had partly closed as a result of forward tilting of teeth behind so that, at lower left, the "gap" was reduced by around 1/3and in the other two areas, by nearly 1/2There were three wisdom teeth clearly visible at upper left and lower left and right. They had not appeared recently but were fully erupted, so that when [A] closed his teeth tighter, the wisdom teeth were in full biting contact with those opposite. There were other areas of decay (caries) much less severe than the gross first molar damage referred to. The only area of relevance was a moderate cavity on the outer wall (nearest the cheek) of the upper left wisdom tooth.
The gum on the fronts of the four lower incisors, as well as in between them, was in a state of chronic (long -standing) inflammation with obvious redness and swelling. The edge of the gum had clearly receded, the more so if one took account of the swelling."
"The OPG, which was well taken, confirms the above points where appropriate. It also shows the upper right wisdom tooth to be buried in the jaw. Root development of the two lower wisdom teeth is very similar, with the tip of the front root fully formed and that of the back root very nearly so.
The roots of the upper right wisdom tooth cannot be seen because the tooth has grown heavily angled outwards so that the roots lie behind the crown on X-ray. The roots of the upper left wisdom tooth appear to be fully formed."
"The most accurate feature is the degree of growth of the wisdom tooth root tips. Applying the A.B.F.0 Study (see reference) [the reference gave a citation for the paper by Mincer and others cited at note 3 of Dr Michie's first report] tables gives results in his case as follows:
Upper Jaw Lower Jaw
50"centile 20.02 yrs 50"centile 20.00 yrs
10"centile 17.58 yrs 10''centile 18.00 yrs
90"centile 23.18 yrs 90"centile 23.00 yrs
So that [A] is most likely to be twenty (20) years of age.
Of the other aspects referred to, none is better than a general guide but;
a) The degree of redness, swelling and recession of the gum in the lower front area is to be expected in the adult, not the child.
b) The wisdom teeth had had sufficient time to erupt fully into contact.
c) The upper left wisdom tooth had been present in the mouth long enough to acquire a moderate cavity (the formation of which is, in itself, usually a slow process).
d) The gross destruction of the upper left and both lower first molars also points to the adult rather than the child.
e) All of these features point to an older rather than younger age, so that;
MY CONCLUSIONS ARE
a) That [A] is, beyond reasonable doubt, at least 18 years of age.
b) That, on the balance of probability he is very nearly 20 years old
c) It is quite possible that he is 23 years old."
"The report of Mr Ritchie appears compelling and may be determinative but I have concerns about the procedure which the defendant must address before permission and any interim relief is determined."
"3.7 What comments may be made of the OPG collected?
The film is not labelled with the client's name, any registration numbers, the right/left orientation or the date on which it was collected. These are routine for most clinical services. As a consequence, a film of his nature could not be used as evidence in any medico-legal situation. Identification is particularly important to asylum seekers. There is no record of the radiation exposure given to [A], the dose used or the equipment employed in the collection of this film. The film shows a vertebral shadow, but demonstrates the third molars clearly. The film demonstrates features evident to the untutored eye of a paediatrician, notably that there are several first molar teeth missing and evidence of decay.
3.8 Can this OPG be employed for accurate age assessment?
No. Although I am not a dental surgeon, the published literature on the subject of age assessment based on the third molar describes significant difficulties in reviewing clients with missing teeth. Missing teeth result in movement of the remaining growing teeth, leading to an altered pattern of tooth placement and eruption. The problem is particularly marked in those who have lost teeth on both sides of the jaw, as is the case with this [A]. I would therefore recommend a second opinion as to the value of using this OPG for age determination.
3.9 What does the reference cited inform one of the methods used in the determination of age from an OPG?
At the risk of violating copyright, I enclose a copy of Mr Ritchie's reference, the only one cited in his report, for your use. Please note that this paper is referenced in my age assessment reports along with a number of others relating to forensic dentistry. A number of points may be made from this reference relating to Mr Ritchie's report as follows:
a) The research work described in this paper is aimed at establishing benchmarks for the use of the third molar in age assessment of American whites aged 14-24 years.
It is not therefore directed at assessment of the type of client in the case of [A], or indeed of comparing this type of age assessment with any other. Clarification of this point is made in the discussion and literature review, first paragraph on page 387, in which it is considered whether one can use the grade of tooth formation to assign a subject a particular chronological age. It is observed that ethnic and socioeconomic variables influence the standards used ("standards based on one locality are biased in terms of their ethnicity and socioeconomic milieu"). I note that Mr Ritchie takes no account of the difference between this client, in any sense of socioeconomic status, nutrition or ethnicity, and the standards he uses based on American whites.
b) This third molar is described on page 379 as "the most variable tooth in the detention" and on page 386 as a "far from ideal development marker". These points need to be kept in mind when examining why the authors find this degree of variability. It is interesting that one does not find this type of comment in Mr Ritchie's report. Reasons for this variability are detailed in the paper, and will be outlined in later points here.
c) This paper cited as his sole source by Mr Ritchie describes two distinct methods of age assessment. It is unclear from his reports or reference to this article which of these methods Mr Ritchie employs. As each has distinct statistical assumptions, it is important to distinguish between them. Both require the dental surgeon or technician to grade the development of the third molar from a radiograph of appropriate quality. The grading technique has 8 stages and was described by Demirjian and colleagues in 1973. In one method the developmental grade may be used to predict chronological age. In the other the developmental grade is treated with a statistical method known as regression analysis to determine thelikelihood or degree of confidence one can have in the client having a particular chronological age. Which method, or both, is used by Mr Ritchie? I note in his reports he does not grade the development of the third molars from A to H as described in this paper. This makes his results impossible to challenge, particularly if the radiograph is not available to other specialists. Once the method and values calculated by Mr Ritchie are available, one might be able to investigate the process of his methods further.
d) If the first strategy is applied, as in Table 4 of this paper, the data bear a clear footnote that the figures displayed are based "just on whites". In other words, the population surveyed in this study. The values are not applicable to other groups for the reasons outlined in notes a ) and b) above, and the first paragraph of page 387 explains in detail why this approach is "far too imprecise to be much use in forensic dentistry". Further, the paper observes that developmental grades E, F and G are "essentially a coin toss whether a subject with one of these three grades is younger or older than 18." (p.387). It is therefore of some importance for Mr Ritchie to state his actual scoring or measurement of [A], rather than providing a final statistic, if this is the method he employs.
e) Alternatively, as outlined in Table 5, a regression analysis may be applied to predict chronological age. This technique provides an estimate of certainty with standard deviations. Several observations may be made by any observer of Table 5. Firstly the footnote indicates the data are used only for "white data" Secondly, no centiles results are given. A third observation is that the regression methodology requires a calculation of observed minus predicted age. If one reviews Mr Ritchie's report relating to [A], it becomes very unclear as to how he has employed these data, as the client is not an American white. Further, it is unclear where the centiles he cites are derived from. Finally it is unclear from his report what values he has used for either the observed or predicted ages of the client in order to apply this method.
f) The paper makes a number of comments on left/right differences in the development of the third molar, differences between the upper and lower jaw, differences between the sexes and the possibility of using sex-specific norms. However none of these points is made in the report from Mr Ritchie, although this is his only source of information cited in the area. The differences relating to ethnicity and socioeconomic background are not recorded in his reports. Are they used? Does Mr Ritchie have other data sources that are not cited?
g) The paper by Mincer et al may be examined further if required. For instance, it acknowledges inter-observer variation (p380) and makes some estimate as to the accuracy of the methods (381-2). These aspects have been researched more recently in works cited in my age assessments and in the references forwarded to you earlier. It is for this reason and based on this literature that I provide some idea of the levels of error inherent in dental assessments in each of my reports."
"How useful are the figures in Mr Ritchie's Report?
Mr Ritchie provided a series of age estimate figures for the upper and lower jaws (to two decimal places), then summarises these to provide an age with no decimal places. He gives as his ranges of age the 10"and 90thcentiles. This is in contrast to the ranges provided by others in the field of age estimation, which are given either from the 5th to the 95" centiles or as ± 2 standard deviations (as in the Mincer paper). It would appear therefore that Mr Ritchie has attempted to reduce the errors on his test interpretation more accurate for reasons that are not stated.
It is unclear as to how or why two decimal places are included at one point in the estimate (giving the impression of considerable accuracy) but left out at another. By what process are these calculated or measured initially, and by what process are they dropped or removed? The answers to this might influence the level of accuracy one might apply to the results of this report.
It will be observed however that using relatively old standards on American white patients, Mr Ritchie's error estimates have an error of ± 2.5 years."
"Dental maturation is subject to genetic and environmental influences. The most significant environmental factors documented in the published literature are nutritional: a number of medications additionally influence tooth development. Genetic influences include a wide range of clinical syndromes that influence tooth development: whether these are absent or poorly developed. Nutritional causes such as dietary sugar influences dental decay and tooth loss. Although [A] has clearly lost teeth in his OPG, the cause or consequence of this does not appear to have been taken into account by Mr Ritchie."
"3.17 Do I agree to the age estimation provided to Liverpool Social Services by Mr Ritchie?
No. I would hold to the observations stated in my report. There are reasons to doubt the value of dental age assessment in the case of this client and their applicability, let alone their validity needs to be questioned. My report attempts to provide a number of age assessment methods, of which third molar eruption is only one. Given the complexity of [A]'s dental development (see 3.8) this more broad approach is likely to provide a better chance of accurate age assessment."
"3.19 What explanation may be given for the differences in findings between Mr. Ritchie and myself?
A number of clear differences between the two clinical examinations exist, although both examinations agree that [A] suffers from dental decay. Mr Ritchie identified 3 erupted third molars whereas I did not identify any. The OPG however demonstrates that due to the disappearance of the first molars on both sides of the lower jaw, the third molars have moved forward, and may to my untutored eye appear to be second molars.
3.20 What other comment may be made of the clinical aspects in Mr Ritchie's report?
Mr Ritchie found a number of acute abnormalities on his examination of [A] and his OPG. This examination had been requested by the Social Services caring for [A]. Given his history of dental pain together with the acute observations, one would have expected the average clinician and Social worker to have responded to the abnormalities detected and to refer this client to a practising dental surgeon for treatment. There is no evidence that this was carried out from the documentation received (although it is possible this has not been submitted). Given the very difficult situation in which the client was placed by Social Services in effectively forcing him to have this examination, one would expect at the very least an appropriate clinical response to the information obtained.
4.0 Conclusions
An age-disputed asylum seeker from Afghanistan, [A], received an OPG radiograph at the request of Liverpool Social Services and Mr Ritchie, a forensic odontologist, in order to ascertain chronological age. The odontologist concerned has a declared conflict of interest in the outcome of any age assessment. The procedure was carried out despite cautions provided by several national British professional organisations and the direct recommendation of the Home Office itself. These are based on the risks of the procedure and the lack of accuracy of the result. There is no evidence provided to show the client provided complete informed consent for the procedure as recommended by the General Dental Council. The OPG supplied does not meet routine clinical standards.
The age estimate provided by Mr Ritchie on [A] (with an error of between 2 and 3 years) cannot be accurate or useful as it does not account for the clinical state of the client and is based on inappropriate standards. The technique employed by Mr Ritchie is not evident from the materials supplied or the reference cited. Published literature relating to dental age determination demonstrates it has been found inaccurate in determining the age of asylum seekers.
An important procedure carried out without evidence of consent has been used contrary to guidelines and recommendations. It has produced unhelpful evidence. A young asylum seeker has received unnecessary radiation.
5.0 Consequences
A number of observations may be made relating to process in this case, some of which might potentially lead to serious allegations relating to the probity and indemnity of those involved. These may of course be irrelevant if notes relating to the consent, registration and documentation of the OPG carried out on [A] exist and have not been forwarded to me.
1. There appears to have been a series of failures in the duty of care, irrespective of [his] chronological age, provided to [A]. As there is no evidence of his competence to consent to medical procedures, the performance of the OPG may represent an assault, exacerbated by the fact that the client may have had no choice in the matter. The procedure was carried out against guidelines from the Home Office and Royal Colleges. There is no evidence in the report of appropriate levels of care of a potential minor having been taken in the process of Mr Ritchie's analysis. These matters should be brought to the attention of the Liverpool Area Child Protection Committee and the role of MS G Martin in arranging this procedure merits careful scrutiny.
2. There have been failures of clinical systems in the provisions of an OPG examination for the purposes of age assessment contrary to guidelines and without appropriate informed consent. The exact mechanism of the arrangement of the OPG in this case is not clear, but would appear to involve the Borough Council rather than a general practitioner or dental surgeon with whom [A] was presumably registered. It is not stated who was responsible for the clinical request in Liverpool (other than a Social worker who probably did not have access to this facility). It is unclear who provided or regulated the investigation. It is unclear whether these parties were aware that the Royal College of Radiologists has recommended that radiographs are not performed for the purposes of age assessment. The issue of clinical records is unclear too. Using the Bolam principle, this standard of care falls below that expected of an average clinical service, and is therefore open to litigation by the client. The Patient Safety mechanisms in the centre involved in takiig these radiographs needs to be informed of these breaches, as does its Calidicott Guardian and the General Dental Council.
3. There has been a missed opportunity to re-measure the client's height: should he have gained height, as indicated in my report, his chronological age would have been readily demonstrated with some degree of accuracy.
4. As this situation has been repeated on a number of clients by Liverpool Social Services, representations may have to be repeated in several centres and to central regulatory bodies. I am not aware of any indemnity system that covers such procedures, performed contrary to national recommendations."
"[2] I am astonished that, having produced his first flawed and erroneous Report, Dr. Michie now changes track and chooses to remain outwith his own field and criticizes my work, of which area he clearly has no worthwhile knowledge.
[3] I repudiate every aspect of his report bar one and I deal with that first. It is not known whether there is any inter-racial variation in age for the various stages of tooth development -the literature, such as it is, is equivocal and there is no information available for Afghani people -not that they seem to be very different from us in facial detail in the same way that, for example, the black races are. This area was regularly of importance during fourteen weeks I spent in Thailand last year dealing with post-Tsunami identification where every recovered body was assessed as to age; the consensus of opinion among the many odontologists present (from many countries) was that, if it occurs at all, racial variation is probably very small. Given that there is a considerable "safety margin" of two years incorporated in my conclusions and that, in any case, any possible racial variation could be in either direction, I do not believe that this area throws any doubt at all upon my conclusion.
[4] MY INDEPENDENCE. Dr. Michie, at his para 3.16 accuses me of potential bias as a "declared Home Office Advisor" and states that I do not "claim membership of an Expert Witness Group".
[5] As to the first point, the advice to the Home Office concerned was related to their HOLMES computer system and occurred some ten years ago -hardly a cause of bias! As to the second point, Dr. Michie clearly does not read very carefully. My statement preamble states that I am subject assessor and a member of the medical sector panel of, and, by implication, registered with the Council for the Registration of Forensic Practitioners. This body was set up some five years ago and requires a far greater degree of peer review for successful application than do the other registers. I have been involved since early days and am considered to be of sufficient status that I am part of a verification process for other dental applicants.
[6] AGE OF CONSENT. It is common ground that valid consent is required for any dental or medical examination and that, in general, those below sixteen years of age cannot give it except subject to Frazer (Gillick as was) competence. Dr Michie makes much of his implication that I mishandled this aspect, far from it -but he did! I spent a considerable time explaining to [A] (via an excellent interpreter) who I was, why I was there, what I wished to do and the implications of that -such had, I was told, been passed on to [A]'s legal representatives and he was present with their agreement. I stressed to [A] that he was quite free to refuse if he wished. During the fifteen minutes or so of this interchange, I observed [A] and noted that he appeared to be a highly street-wise, coherent and self-confident young adult -no timorous adolescent -clearly over sixteen years -competent to give his consent. He knew perfectly well what an X-ray was.
[7] In contrast, Dr. Michie (March 2006) does not appear to have tested for what he calls Gillick competence at all yet, on his front page, below a heading of " ..14 years" he blithely states that "he" ([A]) "gave informed consent verbally"
[8] A recent case in Crown Court has some bearing here as well as on the propriety of X-ray examination -see below.
[9] THE OPG X-RAY ITSELF does not bear a name but its provenance and continuity can easily be verified by Liverpool Social Services, I believe. The original does have left and right marked so it can be easily orientated. It is good, clear film entirely fit for purpose.
[10] THE PROPRIETY OF X-RAY EXAMINATION. Please see Appendix A for my specific attitude.
[11] In general, it is obvious that the risks involved in carefully conducted X-ray examinations are either non-existent or so small as to be not worthy of consideration. I do not know what the figures are but crossing the road is obviously a far riskier undertaking. There must be many hundreds killed or injured in the former occupation but, in the latter, I suspect nil.
[12] I was involved in a recent Crown Court case at Peterborough (I am not sure if it is yet concluded so no details here) where both charge and sentence apparently depended upon the age of the defendant -he was, apparently, an age-disputed asylum seeker -and the trial judge ordered an adjournment, with the express request that I provide an age estimation based upon an OPG X-ray, with the consent of all involved. This I did and my evidence accepted without appearance. I would prefer to rely on the procedure and view of the trial Judge than Dr. Michie's comments.
[13] IN CONCLUSION. Dental age assessment is simply an evaluation of the likely chronological age of an individual based upon the only indicator of growth available at the time (the development of third molar roots) coupled with any clinical evidence that may be present. It is not exact -Dr. Michie's reference to decimal figures is simply laughable -0.02 of a year is about 7 1/2 days -but I have allowed for possible variations and have, nevertheless, never been more certain of my conclusions.
[14] [A] IS, ON THE BALANCE OF PROBABILITY, WELL OVER EIGHTEEN YEARS OF AGE."
"My clients have now had the opportunity to consider their position in the light of all the reports, i.e. Dr. Michie's dated March and August and Mr. Ritchie's dated the 20" June, and the 15"September 2006.
They have decided they prefer the opinion of Mr. Ritchie to that of Dr. Michie, for the following reasons:
1 The primary issue the reports address is the assessment of age by reference to examination of the teeth and of dental X-rays, in particular as regards wisdom teeth, i.e. third molars.
2 Mr. Ritchie is a dental surgeon who has far geater expertise in this respect than has Dr. Michie.
3 In particular, he has pointed out in his first report that Dr. Michie in his stated that your client had no erupted third molars whereas in fact he had three. Dr. Michie now accepts that to his "untutored eye" these appeared to him to be second molars. Further, on this point, he appears to have considered the absence of third molars to be significant but now, in his second report, seeks to discount their significance, in that their presence does not appear to impact at all on his assessment of age.
4 Further, Dr. Michie in his first report stated there was no gum inflammation or damage, again apparently attaching some significance to this, whereas Mr Ritchie noted marked chronic redness, swelling and recession of the gum around the lower front teeth. These are matters that in addition to the development of the third molars and destruction of three first molars he considered to support his assessment of age, which Dr. Michie has not challenged in his second report.
In short, the authority is more confident in Mr Ritchie being correct as regards dental matters in general."
Submissions on the Main Issue
(1) The assessment of age in borderline cases is a difficult matter, but it is not complex. It does not require a trial and judicialisation of the process is to be avoided. It is a matter which may be determined informally provided safeguards of minimum standards of inquiry and fairness are adhered to.
(2) Except in clear cases the decision-maker cannot determine age solely on the basis of the appearance of the applicant. In general, the decision-maker must seek to elicit the general background of the applicant, including family circumstances and history, educational background and activities during the previous few years. Ethnic and cultural information may also be important. If there is reason to doubt the given age, the decision-maker will have to make an assessment of credibility by questions designed to test credibility.
(3) There should be no predisposition to assume that an applicant is an adult, or conversely that he is a child. The social services department of a local authority cannot simply adopt a decision made by the Home Office. It may take information into account, but it must itself decide whether the applicant is a child.
(4) The local authority is obliged to give adequate reasons for its decision that an applicant, claiming to be a child, is not a child...
(5) The court should not be predisposed to assume that the decision-maker acted unreasonably and carelessly or unfairly. It is for the claimant to establish that the decision-maker acted in such a way."
and the Royal College of Paediatrics and Child Heath ("the Kings Fund Guidelines"). Paragraph 5.6.3 includes the following:
"There is not an absolute correlation between dental and physical age of children but estimates of a child's physical age from his or her dental development are accurate to within ± two years for 95% of the population and form the basis of most forensic estimates of age. For older children, this margin of uncertainty makes it unwise to rely wholly on dental age."
Analysis of the Main Issue
The Second Issue
Expert Reports
Conclusion