The girl's first serious injury happened in February 2001, when she was 2 years old.

Her left femur — the upper leg bone that is one of the strongest in the human body — had snapped.

Doctors at Maui Memorial Medical Center who treated Dasia Morales-Kaho'ohanohano uniformly believed she was the victim of child abuse and reported their suspicions to Maui police and to the state office of Child Protective Services.

Two months later, the little girl was back in the hospital, nearly dead from new injuries.

Last month, the Hawai'i Supreme Court denied claims by the state that it had no legal duty to protect Dasia from abuse and found the agency liable for as much as $1.1 million in damages.

Calling it "a landmark case," attorney Vladimir Devens, who represented Dasia, said the Supreme Court has made it clear that "Child Protective Services has a duty to protect a child when given notice that the child has been a victim of abuse."

DHS attorneys had argued that the state was not liable for damages because the child had not been taken into state custody when the injuries occurred.

Lillian Koller, head of the state Department of Human Services, which oversees CPS, now called Child Welfare Services, disagreed strongly with the court decision.

"In effect, this decision means that whenever there is a bad outcome for a child, like in this case, the state will be held liable," Koller said in a written statement. "While making the state pay as a 'deep pocket' is one way to get compensation for an injured child, it is unfair to Hawai'i's taxpayers and it is exasperating for our social workers, whose conduct may be condemned no matter what they do."

"To this day, no one knows how the injuries happened, when they happened and who or what caused them. No criminal charges have been brought against anyone for the injuries. Most importantly, the possibility that the injuries were entirely accidental was never ruled out. Still, DHS was held liable," Koller said.

Private attorney Frank O'Brien, who specializes in Family Court issues, called the ruling "absolutely wonderful, one of the strongest ever issued around the country in favor of the rights of abused children and children who are victimized while in foster care."

"Those of us in Family Court dealing with the issues of abused and neglected children are continually dealing with the conflict between the termination of parental rights, which is a very serious matter, and the risk of leaving or returning a child to the custody of the child's abuser," O'Brien said.

"This ruling makes it very clear: the duty to protect the child is pre-eminent."

HOW IT BEGAN

The Maui case began after Dasia's mother, Denise Morales, and her boyfriend, Daryl Ramos, brought Dasia to the emergency room of Maui Memorial Medical Center at 3:33 a.m. on Feb. 21, 2001.

In addition to the broken leg, the child had "red marks" on her arms, mid-section and upper left thigh.

Doctors later testified that the fracture was "a very severe, rare injury" that could only have been caused by "significant force." There would have been an "audible snap" when the bone broke and the child would have suffered "excruciating pain," according to medical expert testimony.

But Morales told doctors the injury happened in the middle of the night at Ramos' house and must have occurred when the sleeping child rolled off her futon bed and fell two feet to a linoleum floor covered by a throw rug.

The little girl never cried or complained of pain and was taken to the emergency room hours after her mother noticed that her leg "appeared twisted," Morales told doctors.

Ramos backed up that version of events and added that, on the way to the emergency room at 3:30 in the morning, he and Morales stopped at Safeway to buy "cigarettes and juice."

The injured child was placed in a body cast that ran from her chest to her feet, including separate casts for her legs with a bar placed between them to stabilize the fractured femur.

She was released from the hospital after a two-week stay and initially placed in the care of her father, Jarrett Kaho'ohanohano. The father and mother had never been married and shared joint custody of their daughter. She stayed with each parent on alternating weeks.

CPS senior social worker Ellen Brewerton was assigned to investigate Dasia's injuries and determine if abuse was involved.

She first spoke with Maui Police Department Lt. Lloyd Yamashita, who was conducting a criminal investigation.

"He informed her that the injury was one that medical personnel felt could not have been accidental," according to court files.

Brewerton also discovered that Dasia had been treated two weeks earlier at the emergency room for a head injury caused when "she fell off the couch onto a linoleum floor."

Brewerton wrote in her notes that the earlier incident "does show that she falls off couches."

Brewerton was later terminated from her job at DHS for unspecified reasons, according to court records.

She did not return telephone messages requesting comment on this case.

DOCTOR'S SUSPICIONS

Dasia's pediatrician, Dr. William Kepler, told Brewerton that the child's broken leg "was not accidental" but he did not think Morales was responsible for it, instead expressing suspicions about Ramos.

Ramos had a criminal record that included 10 arrests and seven convictions, and was on probation for a 2000 conviction for abuse of a household member — he punched a former girlfriend and bit her on the nose, according to court records.

Neither Morales nor Ramos could be found for comment on this story. A Maui attorney who briefly represented Morales in the Maui civil trial said he did not know how to contact her. Ramos is believed to have moved to Florida, according to attorney Devens.

Concluding that "further investigation was necessary" of Morales and Ramos, Brewerton authorized hospital personnel to release Dasia to the custody of her father.

At Brewerton's suggestion, Morales took a lie detector test administered by Maui police. The results were "inconclusive" but "leaning toward deception," and Morales was retested. The new results were "indicative of deception." Morales then took a third polygraph exam, administered by a private expert, which she passed.

A 'SAFETY PLAN'

Two weeks after Dasia was injured, Brewerton told Jarrett Kaho'ohanohano that the joint custody arrangement would be resumed but that Morales could not take Dasia to Ramos' house and that Ramos could not be alone with the child.

Contrary to CPS rules, those restrictions in the "safety plan" were never put in writing, according to testimony and evidence in the Circuit Court trial of the case, held in 2006 before Judge Joel August.

In late March, Dasia's grandfather, retired Maui Police Captain George Kaho'ohanohano, told Brewerton that there had been a shooting at Ramos' property and that Ramos and another man had been arrested.

Kaho'ohanohano also told the social worker that a month before Dasia's leg had been broken, he had seen "markings" on his granddaughter that "looked like cigarette burns."

"Brewerton apparently did not pursue the alleged cigarette markings" and accepted an assurance from Morales that "all of the people involved in the recent shooting were permanently gone from the (Ramos) property," the Supreme Court said in its ruling last month.

A VISIT TO THE DOCTOR

On April 16, after taking Dasia to spend the weekend at Ramos' house, Morales brought her daughter to pediatrician Kepler's office.

The doctor immediately called for an ambulance to take the child to Maui Memorial Medical Center, because she was in "critical condition," with bruises, broken bones, a torn intestine and bleeding inside her skull.

Doctors said her injuries were the result of child abuse and the little girl was a victim of "battered child syndrome."

During emergency surgery to stabilize her condition, a tourniquet was inadvertently left too long on her left leg, resulting in "significant permanent scarring and deformities to her left leg, according to court records.

The child was then flown to Honolulu for additional surgeries at Kapiolani Medical Center for Women and Children. She was "comatose" when she arrived and nearly died on the operating table, according to trial records. She stayed at the hospital for two months and was eventually returned to the custody of her father.

Jarrett and George Kaho'ohanohano filed suit on her behalf in 2003 against the state, Morales and Ramos. They filed a separate malpractice lawsuit against Maui Memorial and doctors there.

Neither Morales nor Ramos was ever charged with a crime in connection with Dasia's injuries.

JUDGE'S RULING

Following the 2006 non-jury trial in the state case, August awarded $1.12 million in damages to the Kaho'ohanohanos. He ruled the state was 29 percent liable for her injuries, Morales and Ramos were liable for 20 percent each, and healthcare providers were responsible for 31 percent.

The suit against Maui Memorial and doctors there was settled out of court for an undisclosed sum.

Under Hawai'i law in effect when the Kaho'ohanohano's suit was filed, the state must pay damages assigned to Morales and Ramos if they are unable to pay themselves.

That law has since been changed, and the state Attorney General's office unsuccessfully argued in the Kaho'ohanohano case that the new law should be applied retroactively.

Dasia will need to undergo additional surgery in the future, according to Devens.

"She's getting the best of care now and is doing well," he said. "But there are serious concerns about her psychological well-being."

Koller, of the Department of Human Services, said her agency and its attorneys "are reviewing the decision and will take all appropriate action."

DHS attorneys argued the agency often is "sued for intervening 'too early' when taking custody of a child that we determine to be in danger," Koller said.

"Now the Supreme Court has decreed that DHS can be liable if we do not move fast enough to take custody," she said. "It seemed untenable to DHS attorneys that the court would put DHS staff, and the state taxpayers' liability, between a rock and a hard place like this."

Since Gov. Linda Lingle and Koller took office, Koller said, "the public should know that DHS Child Welfare Services Branch has made tremendous strides over the past five years and that our keiki are among the safest in the country."