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Archived Transcript for 8 November 2001: Page51
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51
1 "Ward round Dr Richardson. Limping, nothing
2 definite to see on legs."
3 DR FORLEE: Yes.
4 MR GARNHAM: When was it noted she was limping?
5 DR FORLEE: Presumably by Dr Richardson that morning.
6 MR GARNHAM: Did you notice that, that morning?
7 DR FORLEE: Well, accompanying him, yes.
8 MR GARNHAM: Had you noticed it during the course of the
9 ward round on the 25th?
10 DR FORLEE: No.
11 MR GARNHAM: Had you noticed it during the course of your
12 cursory examination on the 24th?
13 DR FORLEE: No.
14 MR GARNHAM: So the limping appears to have occurred or
15 appears to have become noticeable after the 25th.
16 DR FORLEE: By the looks of things, yes.
17 MR GARNHAM: How was that limping investigated?
18 DR FORLEE: As I recall -- and unfortunately this particular
19 ward round I do not recall as clearly as the night
20 I admitted Victoria -- Dr Richardson examined Victoria
21 and one of the other issues that arose in the ward round
22 was to obtain the skeletal survey.
23 MR GARNHAM: That is an answer to the question what was done
24 about the limping because that would be a way of
25 investigating the limping.
52
1 DR FORLEE: She would have been examined on the ward round
2 and X-rays were the next step.
3 MR GARNHAM: Was there any other steps taken to investigate
4 the limping to your knowledge?
5 DR FORLEE: Other than examining her, no, not that I am
6 aware of.
7 MR GARNHAM: "Her right eye said to be swollen".
8 DR FORLEE: Yes.
9 MR GARNHAM: Had you noticed that before on either of the
10 two occasions you say you had seen her?
11 DR FORLEE: No, but that is not unusual for swelling to
12 develop post burn injury.
13 MR GARNHAM: "The nail on the little finger of the left hand
14 was coming off. Does not look infected underneath."
15 You had not noticed that on either of the two
16 occasions you had seen Victoria?
17 DR FORLEE: My recollection of seeing Victoria on the 25th
18 is quite vague so I cannot comment specifically. I am
19 not sure if she was in the room when when we had the
20 discussion or not because the nurses were bathing her at
21 that stage so that I cannot recollect clearly, but
22 I certainly had not specifically noted that on the 24th.
23 MR GARNHAM: "Burn looks not infected. Healed lesions on
24 hands."
25 What were the lesions on the hands?
53
1 DR FORLEE: As I recall those were the sort of dark scarred
2 lesions.
3 MR GARNHAM: P in brackets means plan?
4 DR FORLEE: Yes.
5 MR GARNHAM: "X-rays, discuss at psychosocial meeting today.
6 DW ..."?
7 DR FORLEE: Discuss with dermatologist.
8 MR GARNHAM: "... to see photographs".
9 Do you know how each of those steps in the plan were
10 to be taken forward? Who was responsible for dealing
11 with each of those?
12 DR FORLEE: I cannot remember the specifics but the usual
13 procedure would be that they that there would be two
14 SHOs present on the ward round and it would be fairly
15 random who actually wrote in the notes.
16 MR GARNHAM: Who was the other one with you on the 26th?
17 DR FORLEE: I cannot remember specifically.
18 MR GARNHAM: Who was the other one with you on the 25th?
19 DR FORLEE: Again, I cannot remember specifically.
20 MR GARNHAM: I interrupted you, you were telling us.
21 DR FORLEE: Someone, it is fairly random, writes the notes
22 and then it would be one or the other who would actually
23 cover the ward and the other would cover another area
24 for the day, so I cannot remember whether I was on the
25 ward that day or not, and I think I probably was not but
54
1 I cannot be certain.
2 MR GARNHAM: Would it have been the responsibility of one or
3 other SHO to ensure these four steps in the plan were
4 taken out?
5 DR FORLEE: Yes.
6 MR GARNHAM: Do you recall whether it was your
7 responsibility?
8 DR FORLEE: I do not recall and I think it probably was not
9 therefore.
10 MR GARNHAM: The answer to this must follow but I will ask
11 it nonetheless. Did you carry out, did you ensure any
12 of those steps were taken forward?
13 DR FORLEE: As far as I can recall I was not specifically
14 involved so I think I was covering the other area that
15 day.
16 MR GARNHAM: And that must mean that you did not ensure any
17 of those four things were done because you say it is not
18 your job.
19 DR FORLEE: On that particular day I think that would have
20 been the case.
21 MR GARNHAM: Do you know whether photographs or the result
22 of the dermatological opinion or any of the other
23 information gathered here would have been sent to social
24 services or to the police? Would that normally happen
25 or do you not know?
55
1 DR FORLEE: As I said I had not really been involved in
2 a serious child protection case before.
3 MR GARNHAM: So you do not know?
4 DR FORLEE: I would assume they would but I cannot be
5 certain.
6 MR GARNHAM: You do not know whether or not they were?
7 DR FORLEE: No.
8 MR GARNHAM: Did you have any further involvement with
9 Victoria after the 26th?
10 DR FORLEE: Not that I recall.
11 MR GARNHAM: Did you have a telephone conversation with
12 Karen Johns, the hospital social worker, the following
13 day, the 27th?
14 DR FORLEE: I may have, I cannot recall.
15 MR GARNHAM: A conversation between you and Johns is
16 recorded it seems in the notes and in the statement of
17 Karen Johns. Can I ask you to have a look at volume 5,
18 251 in that bundle please. What is called an "ongoing
19 recording sheet", completed it seems by Karen Johns for
20 27th July:
21 "Telephone call from Dr Forlee, SHO in paediatrics.
22 Stated that when she completed the child protection
23 forms she was unsure whether facial burns were
24 non-accidental. There are now additional concerns which
25 come from both Dr Forlee and the ward staff, staff nurse
56
1 Sue", and then a number are listed:
2 "Old scars, diagram made. Marks resemble shape of
3 belt buckle. Skeletal survey. Concerns about
4 interaction with mother on admission. Anna in unkempt,
5 dirty dress, no underwear. Mother well kempt. Mother
6 not brought any clean clothes for Anna since admission."
7 Does that remind you of a conversation you had with
8 Karen Johns?
9 DR FORLEE: Yes, that may have taken place.
10 MR GARNHAM: According to the note it goes on:
11 "In my conversation with Dr Forlee I explained that
12 the child protection forms needed to be amended to show
13 doctor's suspicions of NAI."
14 First of all, do you recall being told that by
15 Karen Johns?
16 DR FORLEE: I cannot recall.
17 MR GARNHAM: She is right, is she not, that the CP forms did
18 need to be amended because of the subsequent discoveries
19 that had been made by you and the other medical staff?
20 DR FORLEE: Yes, that would be appropriate.
21 MR GARNHAM: Those child protection forms were not however
22 amended, were they?
23 DR FORLEE: I do not know.
24 MR GARNHAM: We have had a look at them and you have looked
25 at them several times.
57
1 DR FORLEE: There was an amendment.
2 MR GARNHAM: Not to include any of these things?
3 DR FORLEE: Yes, the category -- there was a statement
4 saying this is non-accidental injury, the category is
5 uncertain as I recall.
6 MR GARNHAM: Quite right, thank you for that correction.
7 None of the others, old scars, diagrams, marks the shape
8 of belt buckles?
9 DR FORLEE: That would have been included in the diagram,
10 the body map that was done.
11 MR GARNHAM: Was the body map included in the CP forms then?
12 DR FORLEE: Yes.
13 MR GARNHAM: It was. So you say that the body maps that
14 were completed on the 26th July were then added to the
15 CP bundle?
16 DR FORLEE: Yes.
17 MR GARNHAM: Were there any other amendments made to the
18 child protection forms?
19 DR FORLEE: I cannot recall specifically.
20 MR GARNHAM: Did you make any amendments to the child
21 protection forms?
22 DR FORLEE: No, I did not personally make any amendments.
23 MR GARNHAM: Do you know whether you reported back to others
24 on the ward Miss Johns' concerns about the need for
25 these amendments?
58
1 DR FORLEE: I cannot recall that conversation with her
2 unfortunately.
3 MR GARNHAM: All you can say is that it may have happened?
4 DR FORLEE: It may have.
5 MR GARNHAM: The note goes on:
6 "Also the parents needed to be told of concerns and
7 referral made to social services".
8 This is what Johns said that she said to you. Was
9 that done?
10 DR FORLEE: Again, I cannot remember.
11 MR GARNHAM: The conversation?
12 DR FORLEE: The specific conversation.
13 MR GARNHAM: I understand that but nonetheless was that
14 done?
15 DR FORLEE: My understanding is that this was a referral to
16 a social worker. I may be wrong in that.
17 MR GARNHAM: What about "parents ... told of concerns"?
18 DR FORLEE: I am not sure. I think that did happen but
19 I cannot be certain.
20 MR GARNHAM: "... agreed that someone would get back to me
21 when this had been done."
22 Do you know whether anybody got back to Karen Johns
23 to confirm that these steps had been taken?
24 DR FORLEE: I do not know.
25 MR GARNHAM: You said that there was an amendment to the
59
1 CP form dealing with the question of whether or not the
2 injuries were non-accidental. Can you have volume 37
3 again please, page 55. The only amendment I can see to
4 that page is the addition of the words over what I am
5 now told is Dr Rossiter's signature, 1.8.99:
6 "What is uncertain is the category."
7 DR FORLEE: And the alteration from "I wish to make further
8 information before committing myself" to "I consider the
9 incident is likely to be non-accidental".
10 MR GARNHAM: That is the intent behind the arrow, is it?
11 DR FORLEE: That is how I read it, yes.
12 MR GARNHAM: Dr Forlee, I have been asked to put to you by
13 one of the interested parties that there were a number
14 of items of additional information which could and
15 should have been passed on to Karen Johns. I want to
16 ask you each of them and I need to know first of all
17 whether you could have passed on this information,
18 whether you should have done and whether you did.
19 So let us take the first, the inconsistent
20 information about family's ages. Do you remember we
21 talked yesterday about the fact that she was too young
22 to have had the eldest child? Could that have been
23 passed on to social services?
24 DR FORLEE: Yes, it could have.
25 MR GARNHAM: Was it?
60
1 DR FORLEE: I do not know.
2 MR GARNHAM: Not by you?
3 DR FORLEE: Not by me.
4 MR GARNHAM: The fact that the family had no health visitor.
5 Could have been?
6 DR FORLEE: Yes.
7 MR GARNHAM: Should have been?
8 DR FORLEE: Yes.
9 MR GARNHAM: Was it by you?
10 DR FORLEE: Not by me.
11 MR GARNHAM: That there had been some previous contact with
12 social workers. Could have been passed on?
13 DR FORLEE: Yes.
14 MR GARNHAM: Should have been?
15 DR FORLEE: Yes.
16 MR GARNHAM: Was it by you?
17 DR FORLEE: Not by me personally.
18 MR GARNHAM: Kouao had said to you that social services had
19 suggested that they would separate her from her
20 daughter.
21 DR FORLEE: Yes.
22 MR GARNHAM: Could have been passed on?
23 DR FORLEE: Yes.
24 MR GARNHAM: Should have been passed on?
25 DR FORLEE: Yes.
61
1 MR GARNHAM: Was it by you?
2 DR FORLEE: Not by me personally again.
3 MR GARNHAM: Victoria was not at school.
4 DR FORLEE: Yes.
5 MR GARNHAM: Could have been passed on?
6 DR FORLEE: Yes.
7 MR GARNHAM: Should have been passed on?
8 DR FORLEE: Yes.
9 MR GARNHAM: Was it by you?
10 DR FORLEE: Not by me.
11 MR GARNHAM: Kouao had said that Victoria had been enrolled
12 in a school but could not remember the name of the
13 school. Could have been passed on?
14 DR FORLEE: Yes.
15 MR GARNHAM: Should have been?
16 DR FORLEE: Yes.
17 MR GARNHAM: By you?
18 DR FORLEE: Not by me.
19 MR GARNHAM: That there appeared to be inconsistencies in
20 Kouao's story. Could?
21 DR FORLEE: Yes.
22 MR GARNHAM: Should?
23 DR FORLEE: Yes.
24 MR GARNHAM: Was by you?
25 DR FORLEE: Not by me.
62
1 MR GARNHAM: Kouao had left a comfortable life in France to
2 come to this country in circumstances which you regarded
3 as bizarre.
4 DR FORLEE: Yes.
5 MR GARNHAM: Could have been?
6 DR FORLEE: Yes.
7 MR GARNHAM: Should have been?
8 DR FORLEE: Yes.
9 MR GARNHAM: Was it by you?
10 DR FORLEE: Not by me.
11 MR GARNHAM: There were what you have described as "darkish
12 marks" on Victoria's body.
13 DR FORLEE: Yes.
14 MR GARNHAM: Could have been passed on?
15 DR FORLEE: Yes.
16 MR GARNHAM: Should have been?
17 DR FORLEE: Yes.
18 MR GARNHAM: Was it by you?
19 DR FORLEE: No.
20 MR GARNHAM: Lesions on Victoria's hands. Could have been?
21 DR FORLEE: Yes.
22 MR GARNHAM: Should have been?
23 DR FORLEE: Yes.
24 MR GARNHAM: Was it by you?
25 DR FORLEE: Not by me.
63
1 MR GARNHAM: Victoria was limping, discovered at the ward
2 round.
3 DR FORLEE: Yes.
4 MR GARNHAM: Could have been passed on?
5 DR FORLEE: Yes.
6 MR GARNHAM: Should have been?
7 DR FORLEE: Yes.
8 MR GARNHAM: Was it?
9 DR FORLEE: Again not by me.
10 MR GARNHAM: Victoria's right eye was swollen. Could,
11 should, was it?
12 DR FORLEE: I do not think that is necessarily relevant
13 because that was a result of the burn injuries which
14 were already known about.
15 MR GARNHAM: Victoria's fingernail was coming off. Could?
16 DR FORLEE: Yes.
17 MR GARNHAM: Should?
18 DR FORLEE: Possibly.
19 MR GARNHAM: Was it by you?
20 DR FORLEE: Not by me.
21 MR GARNHAM: Photographs were being arranged.
22 DR FORLEE: Yes.
23 MR GARNHAM: Could have been, that information could have
24 been passed on?
25 DR FORLEE: I think it was.
64
1 MR GARNHAM: You think it was. Thank you. Plans to discuss
2 the case with a dermatologist?
3 DR FORLEE: I do not know if the plans necessarily were
4 worth discussing with them but certainly any useful
5 information.
6 MR GARNHAM: Could and should?
7 DR FORLEE: Yes, be passed on.
8 MR GARNHAM: Kouao had given different times for the
9 scalding incident. On any view there was a delay in
10 getting her to hospital.
11 DR FORLEE: Yes.
12 MR GARNHAM: Could?
13 DR FORLEE: Yes.
14 MR GARNHAM: Should?
15 DR FORLEE: Yes.
16 MR GARNHAM: Was it by you?
17 DR FORLEE: Not by me.
18 MR GARNHAM: Kouao had, according to your evidence
19 yesterday, given details of changes in accommodation and
20 sub-standard, inadequate accommodation. Could have been
21 passed on to social services?
22 DR FORLEE: Yes.
23 MR GARNHAM: Should have been?
24 DR FORLEE: Yes, probably.
25 MR GARNHAM: Was it by you?
65
1 DR FORLEE: Not by me.
2 MR GARNHAM: Inconsistency in the information about whether
3 or not Victoria had been admitted to the CMH previously.
4 You had two different versions of events. Could have
5 been?
6 DR FORLEE: Yes.
7 MR GARNHAM: Should have been?
8 DR FORLEE: Yes.
9 MR GARNHAM: Was it by you?
10 DR FORLEE: No.
11 MR GARNHAM: I am anxious, having put that list to you in
12 rather punctuated form, to give you the chance to say
13 anything about any of those points that you think you
14 want to, given what you have told us about the role you
15 played, because we are anxious to understand if there
16 was anything wrong with the system that was in place.
17 DR FORLEE: I think I have to say that areas that we
18 covered, areas that we had responsibility changed every
19 day. I was certainly responsible for the care of
20 Victoria on the night of the 24th and then handed her
21 over on the 25th. On the 26th, as far as I can
22 recollect I was present at the ward round but as far as
23 I can recall was not involved in her care that day and
24 was probably responsible for another area, and further
25 than that I cannot specifically recall because there are
66
1 no notes which I have made, and so from that I could
2 only gather that I was not actually involved in her care
3 and as such would not have had responsibility for
4 handing over this specific information to the involved
5 parties.
6 MR GARNHAM: Are you able to help us with how the system
7 should have ensured that happened, and if you are not
8 that is fine, I will ask others.
9 DR FORLEE: I think there needs to be some sort of
10 coordination of what information has been passed on and
11 what still needs to be handed over, and on the other
12 side from the other agencies we need to or medically we
13 need to know what they are up to.
14 MR GARNHAM: Yes, so are you saying that there is a lack of
15 two-way communication between the hospitals, or are you
16 saying that that was in place?
17 DR FORLEE: One assumes that things were happening fairly
18 haphazardly rather than in an organised, coordinated
19 way.
20 MR GARNHAM: And you are saying that there ought to be in
21 place some system by which this information in
22 a comprehensive form can pass freely between the two
23 organisations?
24 DR FORLEE: Yes, I am not sure if that was in existence at
25 the time. I cannot comment specifically. It seems that
67
1 things did not go according to plan but yes, that
2 certainly should be in place.
3 MR GARNHAM: Thank you. One last question. I wonder if you
4 could have page 264 in volume 37 please. There is
5 a note at the top of the page on the right-hand corner
6 that neither I nor a number of others have been able to
7 make out. Can I ask you first of all whether it is your
8 handwriting?
9 DR FORLEE: No, it is not.
10 MR GARNHAM: Can you make anything of it?
11 "VA not done?!" It looks like "Cannot read ?? says
12 does not know".
13 I am afraid that does not make any sense to me.
14 Does it make any sense to you?
15 DR FORLEE: A common abbreviation of VA might be visual
16 acuity but I am not sure if that is specifically so in
17 this case.
18 MR GARNHAM: Is that eyesight to the uninitiated?
19 DR FORLEE: Yes.
20 MR GARNHAM: But you cannot help on that?
21 DR FORLEE: I can only speculate but I cannot be certain.
22 MR GARNHAM: And your speculation would not go beyond visual
23 acuity? I am genuinely trying to get your help and the
24 answer is no?
25 DR FORLEE: No.
68
1 THE CHAIRMAN: Mr Mason?
2 MR MASON: A couple of brief matters Dr Forlee. This
3 morning you described the on-call duties, and
4 I paraphrased it in my written note: "Emergency service,
5 have to pace oneself, get sufficient information for
6 adequate safety and move on". Is that a fair summary of
7 what you said?
8 DR FORLEE: Yes, I think so.
9 MR MASON: In that context would you -- you were asked about
10 getting hold of Central Middlesex notes on the Saturday
11 night. Now, looking back on what you said about Central
12 Middlesex notes in the context of what you thought, do
13 you think the providing emergency service sufficient
14 information for adequate safety includes getting such
15 notes at this stage?
16 DR FORLEE: No. As I think I said earlier on in my
17 evidence, on seeing Victoria and listening to the
18 history presented to me I had sufficient evidence
19 already to assess her as a child at risk and it was not
20 a priority to get those notes that night.
21 MR MASON: You were also asked about whether or not you
22 spoke to Dr Rossiter on the 24th as opposed to the 25th.
23 DR FORLEE: Yes.
24 MR MASON: Look at volume 37, page 57. You were taken
25 through the first section but not the second section.
69
1 "Has the following been informed? Consultant
2 Paediatrician Dr Rossiter. Action needed? Yes. Action
3 achieved 24.7.99".
4 Is that written by you?
5 DR FORLEE: No, that was not written by me.
6 MR MASON: Do you know who wrote it?
7 DR FORLEE: I think Dr Rossiter herself.
8 MR MASON: So that would be her confirmation that she had
9 spoken to you on the 24th, would it?
10 DR FORLEE: Yes, I believe so.
11 MR MASON: Maybe I can ask her about that. Thank you
12 Dr Forlee.
13 THE CHAIRMAN: We will have a short break now. I would be
14 grateful if we could be back by a quarter to 12.
15 (11.35 am)
16 (A short break)
17 (11.45 am)
18 MR GARNHAM: Can we have Dr Forlee back because the Chairman
19 may have some questions.
20 THE CHAIRMAN: Thank you. I should have indicated at the
21 beginning that I wanted to ask you some questions but
22 I want to be clear about some of the questions I would
23 like to ask you about as I am a little uncertain about
24 some of the things, so just to help clarify in my mind
25 if you would, please.
70
1 First of all, you began your year as an SHO
2 in August 1998, is that right?
3 DR FORLEE: That is right.
4 THE CHAIRMAN: And the critical period we are talking about
5 is July 1999.
6 DR FORLEE: That is right.
7 THE CHAIRMAN: So it was really very close to the end of
8 your year?
9 DR FORLEE: That is right.
10 THE CHAIRMAN: So you presumably had gathered during that
11 time quite a substantial body of experience during your
12 year?
13 DR FORLEE: I would say mostly in the medical side in terms
14 of acutely unwell children with medical problems.
15 THE CHAIRMAN: Thank you, but was it, just so I am clear,
16 was it the first time that you had dealt with possible
17 child abuse?
18 DR FORLEE: It was certainly the first time that I had
19 sufficient concerns to admit a child from Casualty for
20 suspected child protection issues, yes.
21 THE CHAIRMAN: So just to be clear, you had seen many --
22 several or many, I do not know -- children in Casualty
23 where there was the possibility of child abuse, child
24 protection, but this was the first time that you had
25 admitted a child?
71
1 DR FORLEE: I would not say I had seen numerous. I had seen
2 a few other children and usually they were quite minor
3 issues which you did not think were serious child
4 protection issues and I may have seen a few of those
5 children in Casualty, but certainly the only time that
6 I had sufficient concerns to admit a child.
7 THE CHAIRMAN: Right. Well for reasons that I need not
8 trouble you with I can say to you that I think
9 I understand a little bit about the pressure on Accident
10 and Emergency wards, so I understand the need for
11 a cursory examination, but could you tell me what was
12 the system for handing over your responsibilities to
13 another doctor?
14 DR FORLEE: Procedure requires you to contact those more
15 senior than yourself when you see the child, and that
16 was the consultant and the Specialist Registrar, and
17 really then the responsibility is handed on to more
18 senior staff because child protection issues are not
19 terribly common and we as junior doctors did not have
20 a huge amount of child protection experience as such.
21 THE CHAIRMAN: Did you think you were handing over to
22 Dr Rossiter or handing over to somebody else?
23 DR FORLEE: Dr Rossiter would take the lead, yes.
24 THE CHAIRMAN: And your conversation with Dr Rossiter as you
25 explained in your answer to Mr Garnham, if I understand,
72
1 I want to be clear about this, was a brief telephone
2 conversation in which you explained your concerns and if
3 I understood you right her response was in effect we
4 need to get to know this child better?
5 DR FORLEE: In terms of the child protection issues, yes.
6 THE CHAIRMAN: And was that the limit of it? I mean did
7 Dr Rossiter advise you anything more at that stage?
8 DR FORLEE: Not at that stage.
9 THE CHAIRMAN: So admitting the child to the ward was on the
10 basis of getting to know her better?
11 DR FORLEE: Well that was the start of the process, yes.
12 THE CHAIRMAN: I mean, Dr Rossiter did not tell you at that
13 stage to do anything in more detail?
14 DR FORLEE: No.
15 THE CHAIRMAN: I ask this because I understand the reason
16 for a cursory examination but the period immediately
17 after that can be of critical importance in terms of
18 assembling essential information, very vital information
19 which could be lost. So I want to be absolutely clear,
20 if I may, in that when you said to Mr Garnham that it
21 could have been a nurse that took Victoria to the ward,
22 it could have been you, and the communication with the
23 ward seemed to be, if I understood right, rather cursory
24 also?
25 DR FORLEE: We certainly would have raised the possibility
73
1 of non-accidental injury here with the ward.
2 THE CHAIRMAN: How would that have been done? Can you point
3 me to it so I can know whether that happened?
4 DR FORLEE: It would not have been documented unfortunately
5 but I would have telephoned the ward to say, "We are
6 admitting a child, these are the circumstances. There
7 are concerns, these are her medical needs" and they
8 would be aware from that point onwards that we would
9 need to observe this child quite closely and obviously
10 be aware that if the parent attempted to remove the
11 child from the ward then we would need to contact the
12 police.
13 THE CHAIRMAN: What did you say were her medical needs then?
14 DR FORLEE: We needed to ensure that she was comfortable.
15 She did have burns and she may have needed pain relief
16 from that point of view. And her burns would have
17 needed to be attended to, dressed adequately and kept
18 clean and tried to ensure that they did not become
19 infected.
20 THE CHAIRMAN: I understand that in terms of immediate
21 medical needs but in terms of child protection that does
22 not touch the issues of child protection.
23 DR FORLEE: Sorry, I think I may have misunderstood your
24 question.
25 THE CHAIRMAN: For example, let me illustrate it if I have
74
1 not put it clearly. Did the ward know that you had done
2 only a cursory examination of Victoria and did you tell
3 them that and did you say that there is now a need for
4 a thorough examination to be done?
5 DR FORLEE: I cannot remember specifically whether
6 I discussed that with the nursing staff.
7 THE CHAIRMAN: Who would have done the thorough examination,
8 had a thorough examination taken place?
9 DR FORLEE: A member of the medical team and as I said
10 before I would have felt it would have been appropriate
11 for me to be supervised had it been me, so someone with
12 some experience.
13 THE CHAIRMAN: So you did not feel that you had the
14 experience to carry out such an examination, so who did
15 you contact to say, "In my view this child should now be
16 thoroughly examined"?
17 DR FORLEE: Well I discussed the case with Dr Rossiter.
18 THE CHAIRMAN: Dr Rossiter was not in the hospital as
19 I understand it.
20 DR FORLEE: No.
21 THE CHAIRMAN: So who would have made the decision about
22 whether or not it was appropriate that evening to do the
23 examination and how to do it? What I am trying to get
24 at, this handover is quite an important issue and there
25 is a very important link here.
75
1 DR FORLEE: I think to be realistic, to fully examine
2 a child fairly late at night when she had already had
3 a rough day was probably inappropriate actually. I
4 think it would have been reasonable for that to be done
5 the following morning, by which time we did have a full
6 complement of doctors and that could have been done at
7 a reasonable hour with appropriate staff around.
8 THE CHAIRMAN: Dr Forlee I understand that, if in fact you
9 can point me to the fact that this was discussed and
10 a carefully considered decision was made to leave it
11 until tomorrow morning. But the impression that I have,
12 and this is what I want to get clear, is that in fact no
13 such discussion took place.
14 DR FORLEE: I could only take advice from my seniors.
15 THE CHAIRMAN: All right.
16 DR FORLEE: So I discussed the case with them and would have
17 taken their advice on the issue.
18 THE CHAIRMAN: All right, let me be clear then. So what you
19 are saying is that the advice that you were given was
20 admit the child on the basis that it would be good to
21 get to know her better but no advice was given on the
22 basis of what to do that evening?
23 DR FORLEE: Not specifically.
24 THE CHAIRMAN: So as far as you are aware, apart from
25 treating Victoria as a child that needed some immediate
76
1 attention and you say made comfortable?
2 DR FORLEE: And made safe.
3 THE CHAIRMAN: Yes, nothing more was done?
4 DR FORLEE: No.
5 THE CHAIRMAN: The next morning you say that you were on the
6 ward round?
7 DR FORLEE: Yes.
8 THE CHAIRMAN: Was it discussed that this examination needed
9 to be done?
10 DR FORLEE: I think it was.
11 THE CHAIRMAN: You have a vivid memory about some things,
12 and I do not want to press you but it would help me
13 enormously if you could say either "yes" or "no".
14 DR FORLEE: Unfortunately that is true, I remember some
15 things very clearly and others not as clearly.
16 THE CHAIRMAN: So you do not remember. Would you have
17 expected it to have been discussed?
18 DR FORLEE: Yes.
19 THE CHAIRMAN: If it was not you that was going to do it,
20 who would you have thought would have done this
21 examination?
22 DR FORLEE: If the person coming on who was at a similar
23 level to me felt competent to do so, they may do it or
24 may defer it to someone more senior than themselves.
25 THE CHAIRMAN: It is a bit difficult for me to understand
77
1 this so you will have to help me if you can. It feels
2 from where I sit a bit hit and miss. Would that be fair
3 or unfair?
4 DR FORLEE: I suppose that is fair comment.
5 THE CHAIRMAN: A couple of other things. I do not want to
6 detain you but could you go through with me the timing
7 of your contact, first of all your attempted contact and
8 your real contact with social services? Could you take
9 me through the timing again?
10 DR FORLEE: Unfortunately I did not document the specific
11 times I phoned them. All I can go on is the record
12 they have made and that is 20.30. I have a vague idea
13 because as I said I saw Victoria somewhere between 7 and
14 8, made the assessment, then spoke to Dr Rossiter and
15 then spoke to social services, having only managed to
16 leave a message, and then as I recall I was busy
17 elsewhere and I think it was actually back in the A&E
18 Department a while later on, at which stage I no longer
19 had the child protection notes, and also Victoria was by
20 now admitted on the ward when I got a telephone call
21 back from Luciana Frederick.
22 THE CHAIRMAN: At a guess, what time are we talking about?
23 DR FORLEE: I thought it was quite late because I had done
24 a bit of work since having admitted Victoria, so it gave
25 me the impression that some time had elapsed and I guess
78
1 made it to be around 11 to midnight, but I cannot be
2 absolutely certain.
3 THE CHAIRMAN: Do you know why there was a long time delay?
4 DR FORLEE: Well, as I understand it social workers are
5 often very busy out visiting other cases and so may not
6 get back to the office immediately. There may be quite
7 a delay before they were actually able to retrieve their
8 messages.
9 THE CHAIRMAN: Just so I am clear because I am not clear at
10 this stage, what were you actually asking the social
11 worker to do that evening?
12 DR FORLEE: The procedure is that we inform them of all the
13 cases of suspected non-accidental injury when we see
14 them, that is the procedure that we follow. And so
15 partly that was fulfilling the procedure and taking
16 their advice on whether they would -- you know, what
17 sort of action they felt was necessary, because I am not
18 an expert in social work issues.
19 THE CHAIRMAN: So first of all it was to provide them with
20 basic information?
21 DR FORLEE: Yes.
22 THE CHAIRMAN: This child has been admitted in these
23 circumstances?
24 DR FORLEE: Yes.
25 THE CHAIRMAN: The second thing was to ask --
79
1 DR FORLEE: For their involvement.
2 THE CHAIRMAN: And did you?
3 DR FORLEE: Yes.
4 THE CHAIRMAN: And what was the response?
5 DR FORLEE: As I recall, their response was that as the
6 child was now admitted we had to also involve the
7 hospital social workers but that we could -- and there
8 was no urgent need for the social worker to see Victoria
9 that night and that we could get back in touch during
10 office hours.
11 THE CHAIRMAN: This was a weekend I think?
12 DR FORLEE: It was a Saturday night.
13 THE CHAIRMAN: So you were not expecting or you were told
14 that no action would be taken at least until some time
15 on Monday?
16 DR FORLEE: On Monday, that was my understanding.
17 THE CHAIRMAN: What did you think of that?
18 DR FORLEE: As I said I am not experienced in their field of
19 work, and as far as I was concerned, as long as we were
20 able to keep Victoria safe during that period, that
21 should be sufficient.
22 THE CHAIRMAN: Just one final question. Mr Garnham towards
23 the end of his questions asked you a whole lot of
24 details: could, should.
25 DR FORLEE: Yes.
80
1 THE CHAIRMAN: And for the most part you and I agree you
2 were saying could and should, but it was not you.
3 DR FORLEE: Or that I personally did not hand that over.
4 THE CHAIRMAN: Who did you think it was the responsibility
5 to do so?
6 DR FORLEE: As I said, it was now a team managing Victoria's
7 case led by a consultant. The practicalities of us as
8 junior members of the team meant that we were not always
9 working on the ward, there were days we almost
10 alternated, one day we were there, one day we were not.
11 I was also very close to the end of my job so I would
12 not necessarily have been a member of that team during
13 the period that we were discussing. So it would be the
14 responsibility of the team led by the consultant and she
15 would generally delegate those tasks to whoever she
16 deemed appropriate.
17 THE CHAIRMAN: So you would have waited for an instruction
18 from the consultant if it was going to be you to do
19 this?
20 DR FORLEE: Yes.
21 THE CHAIRMAN: And no such instruction was given to you?
22 DR FORLEE: Not specifically on that night, and as I say I
23 do not think I was involved subsequently.
24 THE CHAIRMAN: Thank you very much indeed.
25 MR GARNHAM: No further questions from me. Thank you
81
1 Dr Forlee.
2 Before we proceed to our next witness, I indicated
3 this morning there was going to be an application in
4 respect of the presence of future witnesses in the room
5 whilst others give their evidence. I think it is my
6 friend Miss Lawson who wishes to make the point. I have
7 a submission on it but I will invite Miss Lawson to make
8 the point.
9 THE CHAIRMAN: Miss Lawson, thank you.
10 MISS LAWSON: Sir, as you will remember from paragraph 4.19
11 of the procedures of this Inquiry, you reserve to
12 yourself the right in appropriate circumstances to
13 change your usual procedure and to exclude witnesses
14 whilst others gave evidence. My submission relates to
15 the nurses on Rainbow Ward in relation to today's
16 evidence. You will be aware, sir, that both inside and
17 outside this Inquiry there has been considerable
18 criticism of the staff at Haringey for failing to follow
19 up on nursing and medical concerns allegedly raised by
20 the North Middlesex Hospital and you may or may not
21 recall, given how long ago it now is, that it was
22 a matter which I flagged up during my opening, the
23 discrepancies between what the staff noted and said at
24 the time or completely failed to note or say at the time
25 and what they now allege.
82
1 So that in suggesting lines of inquiry and
2 questioning to Counsel to this Inquiry, it is in my
3 submission important to establish exactly what did
4 happen during this period of admission and it is my
5 submission to you that there are significant variations
6 between the accounts of these nurses and not all of
7 which can on the face of it be reconciled.
8 In those circumstances, if this matter were
9 proceeding not as an Inquiry here but in front of
10 a court, where there are significant inconsistencies in
11 relation to issues of fact, I would be asking that the
12 other witnesses are not present whilst the earlier
13 witnesses are questioned and they should not discuss the
14 evidence that they have given until all those
15 witnesses have given evidence. That is effectively my
16 submission to you in relation to this part of the
17 evidence.
18 THE CHAIRMAN: That relates to?
19 MISS LAWSON: It relates to the nurses who are to give
20 evidence today, which I think is everybody except for
21 Dr Banjoko.
22 THE CHAIRMAN: Thank you very much.
23 MISS LAWSON: And I have already indicated that for my part
24 if Dr Banjoko has been on duty for as long as she has,
25 it would seem sensible to get her evidence out of the
83
1 way first.
2 THE CHAIRMAN: I am grateful to you. I think we would all
3 agree with the last part. Is everybody content with
4 that?
5 MR MASON: Sir, I am instructed to oppose the application.
6 I am not sure if it applies to Lucienne Taub who was not
7 a nurse on the ward or to Beatrice Norman who did not
8 play an active role in the care of Victoria. Is it
9 everybody?
10 MISS LAWSON: Yes, it is everybody, sir.
11 THE CHAIRMAN: I think it is safer that we proceed on the
12 basis it is either all or none kind of thing.
13 MR MASON: Sir, it is entirely a matter for your discretion
14 and no legal principles great or small are involved.
15 The nurses are somewhat shocked and upset by this
16 request which certainly from their perspective carries
17 a suggestion that they might tailor their evidence
18 improperly. This of course is not a criminal trial and
19 none of these nurses are subject -- none of the nurses
20 who worked on the ward are subject to any existing
21 letter of criticism. They are a very strong knit team
22 and they have given each other a lot of support after
23 what happened, after they found out what happened to
24 Victoria and since.
25 They have obviously discussed their recollections
84
1 and their thoughts a great deal together over the last
2 18 months, and as my learned friend said, there are
3 inconsistencies in recollection and accounts, which
4 shows that all these discussions have not led to some
5 sort of agreed or official version of events, and there
6 certainly has been no suggestion that they have
7 colluded in some way in preparing their witness
8 statements to avoid inconsistencies.
9 Certainly for my part Mrs Pat Diss -- who has been
10 sitting next to me and is the Trust's Inquiry Officer --
11 and I have spent a lot of time both collectively and
12 individually with these nurses and we certainly made it
13 extremely clear to them that they need to be open and
14 honest with the Inquiry and they must not tailor their
15 evidence to suit either the Trust or their colleagues or
16 indeed anyone else.
17 They very much want to help with this Inquiry.
18 I think I would be pushing a point to say they want to
19 be here today, but they understand the reasons for it
20 and understand the importance of the Inquiry, so I am
21 not quite sure what legitimate interest of Haringey you
22 are being asked to protect.
23 If it was a question of evidence in relation to
24 joint interaction between Haringey staff and North
25 Middlesex staff I might perhaps be able to understand it
85
1 better and be able to explain it to the nurses better,
2 but there was very little interaction of any sort
3 between these nurses and other agencies and such
4 interaction as there was only involved one at a time, so
5 it is not a question of, "Here is what someone at North
6 Middlesex said happened, here is the Haringey version
7 and you have another North Middlesex witness coming on
8 to support the other one".
9 So that their evidence such as it deals with the
10 same area is internal matters to North Middlesex and not
11 to do with interaction. It did not seem to cause any
12 difficulty yesterday with some of the same witnesses and
13 these witnesses know what those witnesses have said, and
14 the Brent police yesterday covered much of the same
15 ground and that did not seem to trouble anybody.
16 I submit that the only real effect of excluding the
17 nurses, beyond adding to their distress, would be to
18 slow these proceedings down because it has to be put to
19 them in detail what each other has said without the
20 benefit of having heard it.
21 I do accept of course -- and we all do -- the
22 importance of things being done right and being seen to
23 be done right, but I submit that that works both ways
24 for these nurses just as much as everyone else in
25 Haringey, and to single them out when there has been no
86
1 other such request -- there is always going to be
2 a first request, but in the absence of a clear
3 indication that they collude in relation to any matter
4 in relation to Haringey itself seems to me to be
5 inappropriate.
6 THE CHAIRMAN: Thank you Mr Mason.
7 MR GARNHAM: As Mr Mason says this is the classical example
8 of the exercise of your discretion. When I opened the
9 Inquiry I invited you to reserve the power to give
10 a direction of this sort to yourself, and you accepted
11 that invitation, and as a result the provision to which
12 Miss Lawson refers is found in the procedural guidance
13 that we produced. It does seem to me that there will be
14 occasions on which there may be benefit in excluding
15 witnesses in the way that Miss Lawson suggests. Our
16 provisional view is that there may be at least two
17 further occasions in the future when we as Counsel to
18 the Inquiry would invite you to exercise such
19 a discretion.
20 My submission is that there may be merit in what
21 Miss Lawson says on the facts here, if for no other
22 reason than that if the course she suggested is
23 followed, the quality of the evidence you receive from
24 the nurses may be that much stronger because you will be
25 confident that they will give that evidence without
87
1 consciously or subconsciously being influenced by what
2 others who speak to similar events say.
3 So for that reason and only that reason sir, I would
4 support the submission made by my learned friend
5 Miss Lawson.
6 THE CHAIRMAN: I am grateful to you Mr Garnham and grateful
7 to Miss Lawson and Mr Mason for the way in which they
8 have expressed their submission. I take this as
9 a substantial and serious point and I would like to give
10 it some thought and therefore we will adjourn for a few
11 minutes while I have that opportunity.
12 (A short break)
13 THE CHAIRMAN: Ladies and gentlemen, Miss Lawson, Mr Mason,
14 I am grateful for the way in which you made your
15 application and your response and also Mr Garnham.
16 I do regard this as a very serious point which has
17 exercised my mind a great deal and not for the first
18 time today.
19 I believe that the arguments are finely balanced and
20 it is not possible to reach a conclusion without
21 recognising that it is a fine balance. You will know
22 that my concern is about the integrity of the Inquiry.
23 I am sure everyone else here shares that concern with me
24 and I am grateful for that. Having considered the
25 matter carefully, as you appreciate I and my colleagues
88
1 have done, I have decided to grant the application but
2 I want to make absolutely plain in doing so that I have
3 also in mind the need to remove any other implication
4 from the witnesses that we will hear later today. Thank
5 you very much.
6 MR GARNHAM: Sir, thank you. In the light of comments that
7 have been made there may well be merit in Dr Banjoko
8 being heard next. The possibility of sleep for
9 Dr Banjoko may become attractive as the day wears on and
10 we would quite like to hear that evidence first. So
11 perhaps then I will ask Ms Gibson to take that witness
12 and from then on, from now on, we ask other NMH
13 witnesses to withdraw.
14 THE CHAIRMAN: After Dr Banjoko?
15 MR GARNHAM: I am in your hands sir, but I understood you to
16 say that the better way to deal with it was to treat
17 them all the same.
18 THE CHAIRMAN: I wanted to be plain what you were asking.
19 From now on, thank you. I am grateful that we can help
20 Dr Banjoko, if help it is, in that way.
21 DR OLUTOYIN BANJOKO (sworn)
22 MS GIBSON: Good afternoon Dr Banjoko. If you could give
23 the Inquiry your full name and professional address.
24 DR BANJOKO: My name is Dr Olutoyin Banjoko and I am
25 a registrar currently working at St Mary's Hospital in
89
1 Paddington in an ICU.
2 MS GIBSON: I wonder if you could be supplied with a copy of
3 the statement you made for the Inquiry which is found at
4 volume 6, page 27 of the witness bundle. Would you
5 check that that is a copy of your statement with your
6 signature at the end?
7 DR BANJOKO: Yes, it is.
8 MS GIBSON: Can you confirm whether the contents of that
9 statement are true?
10 DR BANJOKO: Yes, it is.
11 MS GIBSON: Are there any amendments you would wish to make
12 at this stage to that statement?
13 DR BANJOKO: Yes.
14 MS GIBSON: There is an amendment?
15 DR BANJOKO: Yes, there is an amendment.
16 MS GIBSON: Perhaps you could tell us what that is now.
17 DR BANJOKO: Okay. On page 4 of the statement, number 11,
18 it says on the second statement there:
19 "I therefore decided to admit Victoria overnight so
20 that she could be reviewed by Dr Rossiter, consultant
21 paediatrician in the morning."
22 I will try and put that a bit more into context.
23 What it is is when a child gets referred by Casualty,
24 they usually bleep the SHO who is on-call and if I am
25 there present with the SHO, as it was in this case, she
90
1 would discuss what they said and in this case it was to
2 review a child who subsequently had scabies and had hot
3 water poured over her head, so even before the SHO saw
4 the child there were times we would discuss about it and
5 go down management lines. And I remember in this
6 particular case we had said, "She will go and see what
7 the child is like, then let me know her findings, but it
8 is from the sound of things, with scabies and hot water
9 over the head and burns, we will probably have to admit
10 Victoria overnight."
11 MS GIBSON: I may ask you some more about that later but
12 that is your amendment at this stage?
13 DR BANJOKO: Yes.
14 THE CHAIRMAN: So I am clear, what was the amendment?
15 MS GIBSON: It is to paragraph 11 of the statement?
16 DR BANJOKO: Yes.
17 MS GIBSON: And you are talking about your decision?
18 DR BANJOKO: Yes, it is to say that even before Dr Forlee
19 saw Victoria we had had it planned that we would
20 probably be admitting her for medical reasons because of
21 the scabies and also because of the hot water around the
22 head.
23 MS GIBSON: So the decision to admit Victoria came before
24 you spoke to Dr Forlee following her examination? It
25 was at the time you received or she received the bleep
91
1 and discussed the case?
2 DR BANJOKO: At the time she received the bleep there was
3 a strong -- there was a -- I am trying to think of the
4 word -- there was a strong thought as to the fact that
5 we might have to admit Victoria because of the physical
6 injuries that they were describing to Simone.
7 THE CHAIRMAN: I am terribly sorry, I do not want to hold
8 things up. There is a difference between an indication
9 and a decision and I want to be absolutely clear what
10 you are inviting the amendment to be. Are you saying
11 the decision was not made by you or are you saying
12 a decision was made by you but it was on the advice of
13 someone else? I just want to be clear.
14 DR BANJOKO: There was an indication that we would admit
15 Victoria even before Dr Forlee saw her and when
16 Dr Forlee got back to me the decision had already been
17 made.
18 THE CHAIRMAN: Right, okay.
19 DR BANJOKO: For Victoria to be admitted is what I am trying
20 to get across.
21 MS GIBSON: Can you confirm who made that decision?
22 DR BANJOKO: It was made between Dr Forlee and Dr Rossiter.
23 I cannot say exactly who said which words but it was
24 made before Dr Forlee got back to me that Victoria was
25 going to be admitted.
92
1 MS GIBSON: So your statement at paragraph 11 is incorrect
2 because you did not make the decision to admit Victoria
3 overnight?
4 DR BANJOKO: No, it is -- it needs to be amended.
5 THE CHAIRMAN: That is fine.
6 MS GIBSON: Thank you. Going back to your statement, you
7 were Community Paediatric Registrar based at St Anne's
8 Hospital at the time from 9 to 5 and on this particular
9 evening you then went on on-call duty to NMH at about
10 5 o'clock?
11 DR BANJOKO: Okay. No, this role as a paediatric registrar,
12 it is describing what I would do on a Monday to Friday,
13 which will be during the hours of 9 am to 5 pm. I had
14 been the community registrar at St Anne's hospital and
15 if I was on-call then I would go across to North
16 Middlesex. I had to be the on-call from 5 pm during the
17 week. At the weekends if I was on-call then I would
18 start at North Middlesex 9 o'clock in the morning and be
19 on-call until the next morning.
20 MS GIBSON: Right, so you were on-call 24 hours --
21 DR BANJOKO: Yes.
22 MS GIBSON: -- when you were involved in this case?
23 DR BANJOKO: Yes.
24 MS GIBSON: It was a 24 hour on-call. Thank you. Your
25 initial training was at medical school in Lagos. That
93
1 is in Nigeria?
2 DR BANJOKO: That is right.
3 MS GIBSON: During that training did you have any experience
4 of dealing with cases of scabies?
5 DR BANJOKO: Yes.
6 MS GIBSON: Would you say that scabies was more prevalent in
7 Nigeria than in the UK?
8 DR BANJOKO: Probably yes, I would say that, yes.
9 MS GIBSON: You have some experience of treating scabies in
10 your medical training?
11 DR BANJOKO: At some stage, yes.
12 MS GIBSON: We know that you saw Victoria on Rainbow Ward
13 that evening. Did you make any assessment of her skin
14 condition?
15 DR BANJOKO: When I saw Victoria that evening she had the
16 superficial scalds around her hairline, she had some
17 whitish cream on her hands and on her body, and apart
18 from that I did not make any further assessment of her
19 injuries.
20 MS GIBSON: Do you recall now whether you saw a rash on
21 Victoria that was consistent with a scabies rash from
22 your experience, and if you cannot recall please say so.
23 DR BANJOKO: At this stage I cannot recall.
24 MS GIBSON: Can I ask you how good your recollection is of
25 that particular evening and your dealing with the case?
94
1 DR BANJOKO: I think they are quite good.
2 MS GIBSON: We know that this event is some time ago so can
3 you help with why your recollection is so good after
4 such a long delay? What is it about this case that
5 sticks in your mind?
6 DR BANJOKO: I mean one of the statements about this case
7 that really sticks in my mind was the fact that
8 Dr Forlee, after she got back to me, said the mother
9 looked very well kept and that Victoria was quite unkept
10 and that was something that stuck in my mind about this
11 case, and I mean all the other things I have to go by,
12 things I remember from the case really.
13 MS GIBSON: Is there anything else aside from that that
14 particularly fixes this case in your memory,
15 particularly what happened when you went to the ward and
16 saw Victoria with Kouao?
17 DR BANJOKO: I would say what fixed this case in my memory
18 is the fact that it is unusual for a child of that age,
19 even if they are itching, to pour hot water on
20 themselves, you know, that is something I found
21 puzzling.
22 MS GIBSON: Did that heighten your concern that this was
23 a case of child abuse, of physical child abuse?
24 DR BANJOKO: Yes, it did.
25 MS GIBSON: You have also spoken of the differential
95
1 appearance between the parent, mother at that stage, and
2 Victoria. Is that something which would heighten your
3 concern that this was a case of abuse?
4 DR BANJOKO: Yes, it would.
5 MS GIBSON: What would the significance be of that
6 differential appearance?
7 DR BANJOKO: I mean, I would expect a mother who was well
8 kept to look after her child well, so it is quite
9 significant to me that you have a mother who looks very
10 well, is well dressed, and you have a child who looks
11 unkempt.
12 MS GIBSON: So it is different from the situation where
13 perhaps you have someone who may be from an impoverished
14 background who themselves is not terribly well kept and
15 the child is in a similar state, that might not
16 necessarily point to lack of care on the part of
17 a parent?
18 DR BANJOKO: That is right, yes.
19 MS GIBSON: Can you describe what your duties as a registrar
20 would be?
21 DR BANJOKO: Okay.
22 MS GIBSON: What I am particularly interested in is your
23 duty concerning the supervision of the senior house
24 officer in this case.
25 DR BANJOKO: Under normal procedures if Accident and
96
1 Emergency rang and if a child presented to Casualty and
2 there was a suspicion of child abuse, then Accident and
3 Emergency would get the registrar straightaway. They
4 would not go through the senior house officer. So the
5 registrar would be the first person on the line who
6 deals with the child.
7 In this case the child was referred as a scabies
8 with some burns to the SHO who went to assess the child,
9 and I think because Dr Rossiter was on-call that night
10 and because Dr Rossiter is the named child abuse
11 consultant, Dr Forlee felt comfortable to go ahead and
12 ring Dr Rossiter at home. Had it been another
13 consultant on-call she might have felt more comfortable
14 to involve me at that stage but she went ahead and spoke
15 to Dr Rossiter, which was the right thing for her to do,
16 because I eventually would have gone ahead to speak to
17 Dr Rossiter. So she went ahead and spoke to Dr Rossiter
18 and they agreed a management plan.
19 MS GIBSON: You say that she was comfortable to phone
20 Dr Rossiter at home. Why do you make that distinction
21 in the case of Dr Rossiter as compared to another
22 consultant?
23 DR BANJOKO: The reason I make that decision is because in
24 medicine especially when you are on-call there is a bit
25 of a hierarchy. The senior house officers are expected
97
1 to report to the registrars and then if the registrars
2 need further guidance then they get the consultant
3 involved. So there the reason I say she was comfortable
4 is because she knew Dr Rossiter was on-call that night,
5 she knew she was the lead person for child abuse and she
6 knew Dr Rossiter was a very approachable consultant, so
7 that is why I make that statement.
8 MS GIBSON: You say that she knew that but how did you know
9 that she knew?
10 DR BANJOKO: Okay. Obviously if she did not feel
11 comfortable contacting Dr Rossiter at home she would
12 have contacted me straightaway and informed me first
13 about her concerns.
14 MS GIBSON: Are you aware of the child protection guidelines
15 for North Middlesex Hospital?
16 DR BANJOKO: Yes, I am.
17 MS GIBSON: And can you describe what your awareness is?
18 Have you read those thoroughly, do you refer to them
19 frequently?
20 DR BANJOKO: I have read them before and yes, I refer to
21 them when I am involved in a case where there is child
22 protection issues.
23 MS GIBSON: Could you have a look at volume 39 please and it
24 is page 223. You have that there and you will see under
25 "Assessment" what the assessment must consist of under
98
1 those guidelines, and it is stated that it is important
2 that any allegations of abuse should be investigated
3 within 24 hours.
4 DR BANJOKO: Yes.
5 MS GIBSON: "It is also important to examine the child fully
6 to assess any injuries in the light of explanations
7 given."
8 Can you explain from your perspective what the
9 importance is of that 24 hour time qualification when
10 one is dealing with a case of child abuse or suspected
11 child abuse?
12 DR BANJOKO: As far as I am aware the importance of that is
13 to make sure that all the injuries are documented within
14 the first 24 hours so that if further injuries arise at
15 a later stage, then we can say they were not there
16 within the first 24 hours.
17 MS GIBSON: So that is perhaps to take away any suspicion if
18 the parent may subsequently allege that the injuries
19 happened on the ward and it may be the responsibility of
20 nursing staff for example, because we have heard of
21 cases where children have been injured by nurses.
22 DR BANJOKO: I am sure that is one of the reasons, yes.
23 MS GIBSON: And important also, is it not, to ascertain the
24 reaction of the parent to any allegation of abuse?
25 DR BANJOKO: Yes.
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1 MS GIBSON: And it is vital, is it not, to obtain a clear
2 history from the carer of the child?
3 DR BANJOKO: Yes, it is vital to obtain a clear history but
4 there are times when that has to be done under
5 controlled circumstances.
6 MS GIBSON: Can you explain what you mean by that?
7 DR BANJOKO: What I mean by that is in a case whereby
8 a carer has already been questioned and their reasons as
9 to the nature of the injury has already been written
10 down, when you approach them or when you raise your
11 concerns about the fact that they might be responsible
12 for that injury, it has to be done I think when -- it
13 has to be done when people who are the experts at or
14 dealing with such things are around.
15 MS GIBSON: Is it not important that at the very first stage
16 the medical professional dealing with the case makes
17 sure that they get a clear and comprehensive account
18 from the carer so they cannot resile from that account
19 at a subsequent stage?
20 DR BANJOKO: It is important and I think we did that in this
21 case.
22 MS GIBSON: And you feel that Dr Forlee's recordings of the
23 history were adequate in this situation?
24 DR BANJOKO: Yes, I do.
25 MS GIBSON: Can you look at page 241 in those guidelines.
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1 This deals with admission on to the ward and at that
2 stage a record should be made of the child's height and
3 weight. Who was responsible for ensuring that that is
4 done as soon as the child is admitted on to the ward?
5 DR BANJOKO: Usually the nurses would weigh the child and
6 plot the child's height and record it on the observation
7 charts or there are times when it has been done already
8 in Casualty and it will be in the Accident and Emergency
9 account.
10 MS GIBSON: We know in this case that that did not happen on
11 Casualty and it did not happen on the ward until some
12 days later. Can you give any explanation for that?
13 DR BANJOKO: No, I cannot.
14 MS GIBSON: If you could look at page 263, that deals with
15 the medical examination which should take place and the
16 purposes of the examination: firstly to assess the
17 child's physical and emotional well-being. Would you
18 say that that was done in this particular case?
19 DR BANJOKO: Yes.
20 MS GIBSON: By Dr Forlee?
21 DR BANJOKO: By Dr Forlee yes.
22 MS GIBSON: Secondly to collect and obtain medicolegal
23 evidence for the purpose of protecting the child. Would
24 you say that was done in this case?
25 DR BANJOKO: Yes.
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