A baby boy died in his family home after swallowing heroin substitute methadone, an inquest has heard.
One-year-old Jackson Curtis Howell was found unresponsive by his mum after he fell asleep while his dad ate cornflakes.
Jackson, from Middlesbrough in the UK, was rushed to James Cook University Hospital after the incident in 2017.
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Despite more than an hour of life-saving efforts, the 12-month-old passed away less than six hours later.
Jackson's parents Anne-Marie Howell and Andrew Jon Howell were each charged with manslaughter and causing or allowing the death of a child and manslaughter but were later cleared of the charges, Mirror UK reports.
Prosecutors dropped a manslaughter case against the pair in December 2018 after it was ruled his his death could equally have been caused by naturally occurring bronchopneumonia as from potentially lethal quantities of methadone.
Teesside Live previously reported how a review into the death found how Jackson was likely to have suffered significant harm from neglect even if he hadn't ingested the fatal drugs.
The "active and playful" youngster was at home with his dad where the pair had watched a movie before he fell asleep on the sofa.
However, when mum Anne-Marie returned home, she found him grey and unresponsive while Andrew sat in front of him on the sofa eating cornflakes.
The parents told how they 'loved Jackson to bits' and 'did their best to save him' during the hearing.
Senior coroner Clare Bailey outlined how the inquest was listed to take place on October 4, last year, but Andrew Howell requested for the hearing for be adjourned in order to obtain legal representation.
However, Anne-Marie Howell was able to obtain representation. Housewife Anne-Marie and Andrew Howell attended the inquest and sat in the front row of the Middlesbrough court.
A post mortem report said level of methadone in the Jackson's system was potentially fatal, however there was also low levels of cocaine and morphine in his system. There was also caffeine and nicotine detected.
Hair samples also revealed repeated exposure to cocaine, methadone and heroin. Pathologists Dr Annavarapu and Dr Egan could also not determine if Jackson had built up a tolerance to methadone.
The medical experts also found that Jackson had bronchopneumonia - although it could not be determined if the child had the chest infection before admission to hospital or whether he developed it while receiving treatment.
It was determined that Jackson died as a result of bronchopneumonia and the effects of methadone.
Forensic scientist Mark Tyler explained the toxicology findings, including blood and stomach contents.
He outlined how Jackson had 0.31mg per litre of methadone in his system, the cocaine breakdown product, caffeine and nicotine in his system.
Mr Tyler stated that the methadone concentration levels were "significant", referring to the levels that an adult who has been prescribed methadone for heroin addiction or "possibly abusing methadone".
"But it also falls within the range of methadone toxicity," he added.
"Methadone is not prescribed in children because of the toxic effects."
The inquest heard how methadone can decrease levels of consciousness, slowing down the brain function - "classic signs of methadone toxicity".
Mr Tyler stated that Jackson had 12ml of methadone in his system which he described as a "small amount" equal to around "two teaspoons".
However, he stated that it is "difficult to provide an accurate amount" of how much methadone was in Jackson's system as he couldn't determine how much have been absorbed into the blood stream.
In Mr Tyler's opinion, he believed that it is "most likely that methadone was ingested that day".
Turning to the levels of cocaine, Mr Tyler gave possible explanations that Jackson's levels may have been due to "background ingestion of cocaine".
He stated this may be due to the class A drug in the home, where people are using it, children can pick it up on their hands or be be absorbed if cocaine is smoked.
Mr Tyler also stated that morphine may be in Jackson's system due to contact with heroin powder or if it is smoked. He concluded that these may be "environmental factors" relating to the substances in the child's system.
Dr Arshad Murad was the consultant paediatric at James Cook University Hospital on April 29, 2017, when Jackson was brought into the accident and emergency department after being given a two minute warning call.
Dr Murad outlined how the boy was found unresponsive by his mother of the sofa in the living room. The child arrived at the Middlesbrough hospital shortly before 6.30pm and CPR was in progress by paramedics.
The doctor described how there was "no signs of life and no pulse" and resuscitation was continued as per hospital procedures. Jackson received around one hour of CPR by the medical team at the hospital.
Jackson was transferred to paediatric intensive care where a CT scan was arranged. However, resuscitation was commenced again at 11.15pm and despite the best efforts of medical professionals Jackson passed away shortly before 11.40pm.
The inquest heard how Jackson was an "active and playful child" who was his "usual self" on the day of his death. He lived at home with both parents.
He had a breakfast of toast and scrambled eggs, but did not have any lunch as he was asleep. He also added that Jackson had an "occasional night time cough".
The inquest was told of the hours before Jackson's death as the child fell asleep watching a movie with his dad at home. Dr Murad stated that Jackson had been put on the sofa by dad Andrew Howell who had 'put his hand on his chest and felt his heart beating'.
Andrew had then went to the kitchen to make a bowl of cornflakes and set in front of Jackson on the sofa. Mum Anne-Marie Howell returned home from her brother's house and found Jackson "grey" and "not right".
Anne-Marie Howell then went to phone an ambulance whilst Andrew started CPR. Coroner Bailey asked Dr Murad if he believed experts did everything they could to save Jackson. He replied: "I believe everything was done."
Andrew and Anne-Marie were both on a methadone programme and all children were on a child protection plan. Anne-Marie also had five other children who have either left home or been adopted'.
A health visitor commented that Jackson was well loved and lived in a good home condition. Jackson was "well grown for his age".
The inquest also heard how Jackson had dobutamine in his system - a medication used in the treatment of cardiogenic shock and severe heart failure - which was administered at James Cook University Hospital.
Dr Murad confirmed that Jackson had higher than the recommended dose and a hospital investigation was carried out.
It was confirmed that dobutamine did not contribute to Jackson's death. Dr Murad stated that the higher dose was administered "in error" however, it was quickly rectified as soon as doctors realised.
Coroner Bailey also referred to findings by a judge which revealed that a possible explanation of a "spillage" of methadone, as proposed by Andrew Howell, was rejected.
It was also outlined that both parents failed to share with the court the truth about how Jackson came to ingest methadone and both parents failed to disclose information. The findings stated that it was not possible to determine how much methadone Jackson consumed or the circumstances how it was ingested.
Detective Sergeant Butcher at Cleveland Police, who led the investigation into Jackson's death, attended the inquest and gave
evidence. He told how the parents were arrested following the toxicological results.
The inquest heard how at the time, Andrew Howell stated: "This is because of the methadone it's come back in him hasn't it." He then said: "It's from the tissue isn't it."
The pair were interviewed and bailed. The inquest also heard how the pair had used heroin and cocaine and were on a methadone programme. Anne-Marie had the methadone in a locked box in the bedroom.
They also tried to wash out the empty bottles of methadone after use, he added.
Anne-Marie, 45, confirmed that at the time of Jackson's death she was consuming methadone twice per day or "just when she needed it".
She stated that she "couldn't remember" if she had consumed methadone on the day of Jackson's death or if methadone was consumed anywhere else in the house.
Speaking about when she realised there was something wrong with Jackson, Anne-Marie stated: "I just panicked. "I just looked at him and knew he wasn't right. He was a funny colour. He was grey or blue.
"I have tried to put it out of my head. I just thought I need to phone an ambulance. I went and got an ambulance.
"It's not something you can forget but it's not something you want to remember either," she added. Andrew Howell was questioned about his police statement about the methadone "spillage".
He stated: "I don't know how he got methadone". In response to the disclose over the substance in the "tissue", Andrew Howell stated that the pair had been told that tissues from Jackson's stomach had been taken for examination.
Coroner Bailey asked Mr Howell if he had put methadone in Jackson's bottle to "help him sleep".
He replied: "No, not at all. Why would I do that. He didn't cry much, he was a pleasant baby."
He added: "If he looked grey I would have done something. I remember giving him the kiss of life and CPR. I was blowing into him so he couldn't of been [breathing]."
When asked if he accepted that Jackson access methadone in the house, Mr Howell responded: "It must have been mustn't it. Me or Anne-Marie didn't give him it so I don't know what went on."
Andrew Bridgeman, representing Anne-Marie Howell, argued it was not a possible to reach a conclusion of unlawful killing as there was insufficient evidence.
Coroner Bailey agreed stating that it was "not appropriate" to reach a verdict of unlawful killing.
Before a conclusion was read aloud to the court, Andrew Howell stated: "Me and Anne-Marie loved Jackson to bits. We did our best to save him. If we could we'd swap places with him straight away."
Coroner Bailey stated that neither parent "gave a clear picture of events" in the time leading up to Jackson's death.
She recorded a narrative conclusion stating that Jackson was discovered unresponsive at home on the afternoon of April 29, 2017.
He was transported via ambulance to James Cook University Hospital. Jackson died as a result of combination of bronchopneumonia and methadone. It is not known how, when or quantity in which he ingested the methadone.
A 21-page serious case review into how authorities dealt with the family was published by South Tees Safeguarding Children Partnership following the death.
It found: "Even without (the child) ingesting the drugs which led to his death, he was likely to be suffering significant harm due to neglect."
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