Amy Smith murder trial: Baby given second dose of drug 'hours before her death'
THE second dose of a drug given to a six-week-old baby had to have been given just hours before she died, a court has heard.
Michelle Smith, 34, is on trial accused of murdering her young daughter Amy.
A leading doctor has told the jury at Swansea Crown Court a dose of adult painkiller dihydrocodeine must have been given around noon on November 9, 2007.
The court has already heard from health visitor Gillian Davies who left the family's then Morriston home just minutes earlier and reported Amy looking happy and healthy.
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Smith told police she put Amy down for a nap in the afternoon and when she went into her room, she could not wake her.
An ambulance was called at around 4.15pm but efforts to resuscitate Amy failed and at around 11pm, Amy was declared dead.
Toxicologist Robin Braithwaite told the jury: "One can only really think that the drug was administered to the child some time after the health visitor came.
"The child was said to be behaving perfectly, there were no signs of drowsiness or floppiness which we would expect if the child was given it half an hour before."
He also said it was "highly probable" dihydrocodeine had caused Amy's death.
The drug, which it is said can cause breathing problems, was found in Amy's body on two occasions.
The prosecution allege Amy's mother, Michelle Smith, of Brynawel, Cimla, murdered her by giving her "at least" two doses of the adult painkiller.
Smith, who is on trial at Swansea Crown Court, denies murder and an alternative charge of allowing or causing her death.
The drug was first found in Amy's system after a urine sample was taken on October 23 when Amy was admitted to hospital. A second sample of the drug was then found again in a blood test during her postmortem.
Professor Braithwaite said it was "highly unlikely" the blood test, taken weeks after the urine sample was evidence of the same dose of the drug.
A first screening test found the drug on October 26. A second specialised test was then ordered which revealed a "relatively high" reading, Professor Braithwaite said.
He dismissed suggestions the drug could have made it into Amy's system through breastfeeding or could have been given to her at hospital.
He also said suggestions the drug could have been converted from another drug were not possible. He said he had "no doubt" the first evidence of the drug had been given to Amy before her urine sample was taken.
Professor Braithwaite said there was little research about the effect of the drug on children because it is not licensed and rarely prescribed to them.
Doctors from Singleton, Morriston and University Hospital of Wales, Cardiff, hospitals have already appeared at the trial and have all denied prescribing or administering the drug.
Amy was treated at the three hospitals between October 15 and November 3. At her first examination her parents reported she was floppy, had not been easy to wake and was off her food.
All of which Professor Braithwaite listed as an effect of dihydrocodeine overdose.
He said the readings of both hydrocodeine and paracetemol suggested a compound drug, such as codydramol or remedeine, had been given to Amy.
The day before, the family's GP Hywel Tomos told the jury Smith and her husband had both been prescribed a variant of the drug in the year before her death.
Professor Braithwaite said it was impossible the drug was still in Amy's system from her treatment at any of the three hospitals.
"It's inconceivable," he added. The child has been away from hospital for one to two weeks.
"There's no possibility we could find that level of the drug two weeks later. We have a child who is perfectly well and two to three hours later is effectively dead.
"There's no alternative explanation.
"The drug is there, it shouldn't be there. It wasn't prescribed to the child, it wasn't prescribed to her in hospital. How can you explain that drug in that child?" he asked. "The answer is she was given a dose which led to her death."
The urine sample taken on October 23 was taken 20 hours after Amy had been admitted to hospital.
Sasha Wass QC, representing Smith, cross- examined Professor Braithwaite about how the drug could have been given at home.
He said he would expect the drug would still be present up to 40 hours after it was administered.
He told Miss Wass just one over-the-counter medicine contained dihydrocodeine.
"I am not so sure how widely available it is," he said.
He admitted it would not be "very easy" to give a child a dihydrocodeine tablet but described how the tablet could be crushed and added to milk.
The trial, which it is expected to run until the beginning of July, continues.