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Archived Transcript for 12 November 2001: Pages
101 to 150
101
1 MR GARNHAM: Thank you. When your paediatric colleague
2 Dr Ruby Schwartz gave evidence to this Inquiry, I asked
3 her about the approach of paediatric consultants to
4 child abuse cases in principle.
5 DR ROSSITER: Yes.
6 MR GARNHAM: And I will if I may ask you some similar
7 questions. Do you see child abuse as the equivalent of
8 a disease process?
9 DR ROSSITER: It is a core part of paediatrics. There are
10 various sections of paediatrics that we need to have
11 core skills in and certainly child abuse is one of them,
12 up with diabetes or asthma or haematology or
13 gastroenterology.
14 MR GARNHAM: If we take out the human agency from child
15 abuse, the condition is in many ways similar to
16 a medical condition, is it not?
17 DR ROSSITER: It is indeed and when we are decision-making
18 we use the medical model as it were.
19 MR GARNHAM: Yes. It has a cause?
20 DR ROSSITER: Yes.
21 MR GARNHAM: Like other medical conditions?
22 DR ROSSITER: Yes.
23 MR GARNHAM: It produces signs and symptoms in the same sort
24 of way?
25 DR ROSSITER: Yes.
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1 MR GARNHAM: There is something that can be treated?
2 DR ROSSITER: Yes.
3 MR GARNHAM: And there are steps that you can take to
4 prevent recurrence or to prevent the "condition"
5 becoming chronic?
6 DR ROSSITER: Yes.
7 MR GARNHAM: So there is merit, is there not, in treating
8 this condition much as you would any other disease?
9 DR ROSSITER: Indeed and that is particularly important when
10 one is looking at timing and priorities.
11 MR GARNHAM: Yes. That would involve, would it not,
12 equating child abuse with disease and child protection
13 with treatment?
14 DR ROSSITER: Child protection is -- well it always includes
15 prevention.
16 MR GARNHAM: That is a better word, I accept that.
17 DR ROSSITER: Yes.
18 MR GARNHAM: That means again, does it not, that as with any
19 other disease the practice should be first to take
20 a full history from the patient?
21 DR ROSSITER: Yes.
22 MR GARNHAM: Similarly, you would expect in other cases,
23 other diseases, to conduct a full examination when first
24 you see the patient?
25 DR ROSSITER: Not always in one step. It depends on the
103
1 state of the child. Usually you would expect a full
2 examination but if the child was too sick to be examined
3 or was too distressed, particularly if it is in the
4 night, then that can be in two parts. So it needs to
5 have been completed but not necessarily at that exact
6 time.
7 MR GARNHAM: And in many ways that is a continuation of the
8 parallel we are drawing between child abuse and any
9 other disease.
10 DR ROSSITER: Absolutely.
11 MR GARNHAM: You would then carry out investigations and
12 tests just as you would with any other disease?
13 DR ROSSITER: Investigations, observations and tests.
14 MR GARNHAM: Thank you. And you then reach differential
15 diagnoses setting out possible causes for the signs and
16 symptoms you observe?
17 DR ROSSITER: In paediatrics we tend to produce what we call
18 a problems list and then from that we have an action
19 plan. I think that talking about a diagnosis and
20 a treatment does not leave it wide enough. We like to
21 look at the wider aspects of any condition.
22 MR GARNHAM: That is true both of child abuse and any other
23 disease?
24 DR ROSSITER: Very much so.
25 MR GARNHAM: If you had in your clinic a child who you
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1 suspected of radiation sickness, let us say --
2 DR ROSSITER: I do not think I ever have.
3 MR GARNHAM: Another condition then. That is the trouble
4 with those sort of obtuse parallels.
5 DR ROSSITER: Try urinary tract infection.
6 MR GARNHAM: Not just now thank you. I want to draw
7 a parallel of a condition which is produced by exposure
8 to some outside element.
9 DR ROSSITER: Eczema.
10 MR GARNHAM: Splendid. If you had a child who was showing
11 signs of eczema, one of the concerns you would wish to
12 ensure was addressed was that you did not re-expose the
13 child to the source of the complaint?
14 DR ROSSITER: Yes.
15 MR GARNHAM: So that you would take steps not to send the
16 child suffering from eczema into an environment where
17 they were likely to get it worse?
18 DR ROSSITER: It is not always possible. Unfortunately if
19 you think for example that there are a lot of pollutants
20 in England or that people have adverse housing, one
21 cannot always remove -- put the child into an absolutely
22 perfect environment and then you have to make
23 contingency plans to do the best you can in spite of the
24 bad environment.
25 MR GARNHAM: You will see where my question is leading.
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1 DR ROSSITER: I think so, yes.
2 MR GARNHAM: Because if you have a child in respect of whom
3 you fear abuse --
4 DR ROSSITER: Yes.
5 MR GARNHAM: -- it is important, as well as treating the
6 signs and symptoms you observe, to ensure you do not
7 return them to the place that abuse occurred.
8 DR ROSSITER: But we do not automatically remove every
9 single child who might have been abused from their home.
10 MR GARNHAM: No, I understand that. It remains nonetheless
11 a concern that you have when you are deciding how to
12 deal with a child who you fear may have been a victim of
13 child abuse not to re-expose them in that way.
14 DR ROSSITER: Yes.
15 MR GARNHAM: Has it been your experience that there is
16 a danger in leaving the follow-up of children who are
17 exposed to these sort of risks to the care of other
18 agencies?
19 DR ROSSITER: It has been of concern to me for quite some
20 time that we have difficulty in finding out what has
21 happened to children whom we refer to social services.
22 I am not talking about a major case like Victoria. I am
23 talking about the 300 cases a year that we deal with at
24 present. I do recall bringing this up at Practice and
25 Procedures Sub-Committee.
106
1 MR GARNHAM: That is of the ACPC?
2 DR ROSSITER: Of the ACPC, yes. It came up under the aspect
3 of audit and I wondered whether we could audit what
4 happened to cases where we had filled in CP forms or
5 that we had made referrals, and the feeling at the time
6 was that this was hell for auditing social services and
7 it was not CPC audited, and if I recall, the decision
8 was to refer that back to ACPC and have further
9 instructions on what they would like us to audit.
10 MR GARNHAM: What happened?
11 DR ROSSITER: Not a lot.
12 MR GARNHAM: Do you mean by that nothing?
13 DR ROSSITER: No -- yes, nothing. Well, it has now because
14 with the new restructured ACPC there is a case review
15 sub-committee on which I have been invited to sit.
16 Unfortunately I have been so overwhelmed with work that
17 I have not been to the first two meetings so I do not
18 know the terms and conditions, but as I understand it it
19 will be looking at those sort of issues, I hope.
20 MR GARNHAM: Can I trace through a little further this
21 problem about returning children to the place where the
22 injuries might have been occasioned. The trouble with
23 the analogy with eczema is eczema is seldom fatal
24 whereas child abuse can be.
25 DR ROSSITER: Yes.
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1 MR GARNHAM: And it can be fatal very quickly.
2 DR ROSSITER: Yes.
3 MR GARNHAM: A child can be returned from hospital one day
4 and be dead the next.
5 DR ROSSITER: Our other problem is that under the Children
6 Act we are asked to talk about significant harm and it
7 is on the one hand you can document significant harm
8 which has occurred, but it is almost like soothsaying to
9 know which of the many children we see is going to be
10 fatally harmed in the future.
11 MR GARNHAM: Absolutely and it is so much easier with the
12 benefit of hindsight.
13 DR ROSSITER: Yes.
14 MR GARNHAM: But nonetheless it must, must it not, be
15 a matter of gradation, that the more serious your
16 concerns and the more serious the risk as you perceive
17 it to be, the more hesitant you should be about
18 returning the child to the home where they might have
19 been abused?
20 DR ROSSITER: And that is why I feel that I cannot make that
21 sort of decision by myself. I have to consult with
22 others and I have to consult face to face. You have to
23 have a dialogue or a round table discussion so that you
24 can understand each other's point of view and if
25 necessary have an argument.
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1 MR GARNHAM: I understand that. But it is dangerous, is it
2 not, in those sort of cases where your level of concern
3 is high and where the risk is high simply to leave it to
4 other agencies to intervene in the hope they do so in
5 time?
6 DR ROSSITER: Yes, it is.
7 MR GARNHAM: Because even if an urgent assessment is
8 requested and conducted, it might not be urgent enough
9 and the child might then already be injured.
10 DR ROSSITER: Yes.
11 MR GARNHAM: We have heard a good deal in the course of this
12 Inquiry about the need to avoid repeated examinations of
13 children.
14 DR ROSSITER: Yes.
15 MR GARNHAM: Am I right in understanding that the importance
16 of avoiding repeat examinations was first put forward in
17 sex abuse cases?
18 DR ROSSITER: I do not know about first but it is the main
19 category that one would think about it because examining
20 a child for sexual abuse is intrusive and very
21 distressing.
22 MR GARNHAM: And classically a type of examination that
23 ought only to be conducted by experts.
24 DR ROSSITER: Yes, we like to plan it. In the guidelines
25 you will see that if there has been a clear allegation
109
1 of sexual abuse within three days then we would start
2 with a medical examination which we do with a forensic
3 medical examiner. I particularly like to do that
4 because it is so important we feel that two pairs of
5 eyes once is better than one pair twice. For less clear
6 cases there would be some form of planning, there might
7 well have been a memorandum interview, there would often
8 have been a strategy meeting and it would then be
9 decided whether it would be appropriate for the child to
10 be examined and by whom.
11 MR GARNHAM: But it is because of the particular nature of
12 an examination that has to take place in a sex abuse
13 case --
14 DR ROSSITER: Yes.
15 MR GARNHAM: -- that there is the particular need to avoid
16 repeated examinations?
17 DR ROSSITER: Yes.
18 MR GARNHAM: It is not quite the same with regard to
19 physical abuse, is it?
20 DR ROSSITER: Absolutely agreed.
21 MR GARNHAM: Of course it is necessary to avoid repeated
22 examinations for their own sake because nobody likes
23 being examined by doctors more often than they have
24 to, but there is not the same inhibitor in physical
25 abuse cases against repeat examinations that there is in
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1 sexual abuse, is there?
2 DR ROSSITER: I would agree with you even more than that
3 because lesions evolve and change. As in Victoria's
4 case, the marks that I saw originally had evolved into
5 the big scabby ones that I described in evidence in the
6 criminal case, and bruises fade.
7 MR GARNHAM: Yes, so we have to regard with some caution
8 explanations provided to this Inquiry, do we not, that
9 people did not want to examine Victoria again because
10 they were fearful of exposing her to repeated
11 examinations?
12 DR ROSSITER: That would only apply to sexual abuse. It
13 would also apply to interviewing of parents.
14 MR GARNHAM: Yes, but that aside, the actual examination of
15 the child's body, there is not an inhibitor against
16 doing it a number of times during the course of the
17 child's stay?
18 DR ROSSITER: Not unless she is embarrassed or distressed.
19 MR GARNHAM: In paragraph 2 of your statement you describe
20 the three particular roles you have in relation to child
21 protection.
22 DR ROSSITER: Yes.
23 MR GARNHAM: You are the designated paediatrician in
24 Haringey and sit on the ACPC.
25 DR ROSSITER: Yes.
111
1 MR GARNHAM: You are the named doctor for child protection
2 in the NMH.
3 DR ROSSITER: Yes.
4 MR GARNHAM: And you have a clinical caseload at the NMH
5 which includes a substantial amount of child protection
6 work.
7 DR ROSSITER: Yes.
8 MR GARNHAM: You then set out for us the nature of your
9 duties as designated doctor and your child protection
10 duties and I am not going to take you through that
11 orally now but I have one or two questions to ask you.
12 You tell us in paragraph 3F in your statement that
13 you make it a priority to attend case conferences and
14 strategy meetings in which you have a major involvement.
15 DR ROSSITER: Yes.
16 MR GARNHAM: You say that as a result you would have
17 attended the strategy meeting on Victoria, had it been
18 held in the hospital.
19 DR ROSSITER: Yes.
20 MR GARNHAM: Similarly, you would have attended a case
21 conference if there had been one.
22 DR ROSSITER: Yes.
23 MR GARNHAM: Why did not you attend the strategy meeting
24 that we have heard about in respect of Victoria when it
25 is outside the hospital?
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1 DR ROSSITER: The time was set by the social worker and it
2 was a time when I had prior commitments. I have
3 actually I hope prepared an accurate account of
4 everything I was doing for the two weeks while Victoria
5 was in. I felt following your opening remarks, sir,
6 that I had better look and see what I was doing and
7 I think I have managed to work out what I was doing
8 virtually every day, every hour for those two days. If
9 you have not seen it, it is available to you.
10 MR GARNHAM: I do not think I have seen that and we can
11 perhaps have a look at that at lunchtime. I am sure
12 that will help enormously.
13 DR ROSSITER: I think if it was the Wednesday morning, which
14 I think it was, I had a prior commitment at the Royal
15 Free Hospital for the examinations.
16 MR GARNHAM: Thank you, that is helpful. Do you know
17 whether you were informed about that strategy meeting?
18 DR ROSSITER: I do not have any direct recollection. I am
19 sure I was. You have to bear in mind that I am invited
20 to strategy meetings on a very regular basis and if
21 I can go I do. If I can change my commitments I do but
22 on this occasion I could not.
23 MR GARNHAM: My concern is simply to understand whether the
24 process of inviting medical staff was working because
25 you may have heard Nurse Norman say in her evidence that
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1 she had no knowledge of there being a strategy meeting
2 on the 28th July and that would obviously be a subject
3 for concern, but you do not say, as I understand your
4 evidence, that you were not aware of it.
5 DR ROSSITER: I was aware of it. I believe that I would
6 normally be the conduit but I would not send staff out
7 into the community to represent me because they have
8 got duties in the hospital. Their priorities have to be
9 to the sick children.
10 MR GARNHAM: So you are the person who decides whether
11 Nurse Norman or anybody else goes to one of these
12 meetings?
13 DR ROSSITER: I might ask her.
14 MR GARNHAM: And it is through you and through you only that
15 she would learn that such a meeting was happening?
16 DR ROSSITER: I do not know. I know that I get invited.
17 I do not know if nurses are also invited. I have never
18 asked them.
19 MR GARNHAM: Do you routinely apply your mind to the
20 question of whether it is necessary to have a member of
21 nursing staff or a doctor at a meeting?
22 DR ROSSITER: I do not think I do, no. I think it was
23 because we were in a climate when it could not happen
24 and one sort of got in the way of not doing it.
25 MR GARNHAM: And the reason it could not happen was because
114
1 they were not held in hospital and you could not spare
2 the staff?
3 DR ROSSITER: That is right and I have on several occasions
4 requested it, as I have done subsequently.
5 MR GARNHAM: Requested what?
6 DR ROSSITER: That the strategy meeting should be in the
7 hospital.
8 MR GARNHAM: It is a potential problem this, is it not,
9 because I suspect we will hear from all those involved
10 that they are terribly busy.
11 DR ROSSITER: Yes.
12 MR GARNHAM: And that none of them can give up the time to
13 travel from their offices to somebody else's, but the
14 net result is that strategy meetings happen without
15 there being in attendance all those who ought to be
16 there.
17 DR ROSSITER: Indeed and since Victoria's tragic death we
18 have put much more concerted effort into it happening.
19 I understand the requirements that the strategy meeting
20 should be in the hospital will be in the new updated
21 ACPC guidelines for both Enfield and Haringey, so it is
22 accepted that it is necessary, though I must say that as
23 recently as last January, at the time of the verdict
24 I failed in considerable attempts to have strategy
25 meetings held in the hospital with considerable delays
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1 in the outcomes that I would have liked.
2 MR GARNHAM: In principle you have won the battle that they
3 should be in the hospital rather than social services
4 offices, have you?
5 DR ROSSITER: Winning.
6 MR GARNHAM: It is of concern however that it is a battle
7 between two agencies because we certainly got the
8 flavour yesterday of strategy meetings being quite
9 important meetings at which -- that is not fair. We got
10 the flavour that psychosocial meetings on the ward are
11 important vehicles for the exchange of information.
12 DR ROSSITER: Yes.
13 MR GARNHAM: And that social workers were often not present
14 at those. We now have strategy meetings happening in
15 social services offices with medical staff not being
16 there, so that there were two meetings without the
17 interchange that there ought to be.
18 DR ROSSITER: Absolutely and I am aware that social services
19 are under time constraints under the Children Act so it
20 puts them in a very difficult position.
21 MR GARNHAM: And it is still not resolved.
22 DR ROSSITER: I am hoping it will be resolved, because if we
23 have hospital based social workers who can actually join
24 our discussions on Monday then they would be able to
25 represent our views with more clarity than if they are
116
1 just taking pieces of paper round, but that would be
2 certainly a lesser decision. It is far better if the
3 meetings can be held in the hospital. It means that we
4 can field large numbers of people, not just myself, and
5 if necessary we can call for let us say a play therapist
6 who can come and join and then go back again.
7 MR GARNHAM: There was no case conference in Victoria's
8 case.
9 DR ROSSITER: No.
10 MR GARNHAM: Why not?
11 DR ROSSITER: I have no idea.
12 MR GARNHAM: Who can call a case conference?
13 DR ROSSITER: In theory anybody can.
14 MR GARNHAM: So why did you not?
15 DR ROSSITER: I do not think I ever have. I could make
16 a citizen's arrest but I have never done so in my life
17 and my method would be to encourage my colleagues in the
18 lead agency, which is social services, to take things
19 further.
20 MR GARNHAM: Given that you have the concerns that you have
21 described about the non-attendance of social workers at
22 psychosocial meetings and the non-attendance of medics
23 at strategy meetings held, why not use the powers you
24 have to call a case conference in a case like
25 Victoria's?
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1 DR ROSSITER: I do not think I would have called a case
2 conference. Had she still been in the hospital and we
3 were -- you are talking about after she left?
4 MR GARNHAM: I am talking about any time.
5 DR ROSSITER: At any time. Whilst she was in the hospital
6 we believed that a Section 47 inquiry was going on.
7 I might say all we knew was that Karen Johns had taken
8 the forms, that she had represented us and she had
9 written in the notes, "I went to the meeting." We were
10 expecting feedback.
11 MR GARNHAM: You saw Karen Johns as your representative at
12 the strategy meeting, did you?
13 DR ROSSITER: Yes, I saw her as our representative initially
14 to start off the concerns. I know that in our
15 guidelines it is laid out what the hospital social
16 worker would do for Enfield cases or Haringey cases, so
17 I was expecting her to represent our initial concerns to
18 make sure that an inquiry started and then to feed back
19 to me or to ensure that feedback occurred.
20 MR GARNHAM: Thank you. You then set out the policies and
21 procedures in North Middlesex for child protection.
22 This is the next paragraph of your statement, at the
23 top.
24 DR ROSSITER: "Attend case conferences to arrange and
25 influence training and audit."
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1 (c) is the guidelines. Is that what you are
2 referring to? It is above "case conferences and
3 strategy meetings".
4 MR GARNHAM: Yes, paragraph 5 and onwards.
5 DR ROSSITER: If it is to be responsible for Child
6 Protection Guidelines -- it then says "see below." This
7 is 5. I do apologise, yes.
8 MR GARNHAM: That is where you set out and explain that you
9 are the editor and main author of the hospital Child
10 Protection Guidelines.
11 DR ROSSITER: Yes.
12 MR GARNHAM: The relevant one you tell us is the one
13 dated March 1998.
14 DR ROSSITER: Yes.
15 MR GARNHAM: Which we have as you will see at 39/221. How
16 do you ensure staff are kept up-to-date in respect of
17 those guidelines?
18 DR ROSSITER: Everyone, all the doctors get an induction
19 from me. We -- it would be part of feedback during
20 clinical work that you would say, "Well, this is what
21 you do" or "this we should have done." This is coming
22 back to the medical analogy. We have guidelines for
23 virtually all the medical conditions that we treat and
24 so we say to people: "Read the guidelines, this is the
25 index, read the guidelines, know what to do when that
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1 case comes back. If there are any difficulties, let me
2 know, and if the guidelines are not working we will
3 change them."
4 MR GARNHAM: So it is an initial induction and then on the
5 job training?
6 DR ROSSITER: On the job training, like an apprenticeship.
7 MR GARNHAM: Is there a copy of the Children Act guidance
8 for the NHS available for staff on the wards?
9 DR ROSSITER: Not the complete Children Act but
10 Betty Cotterman, the previous designated nurse or
11 whatever they were called then, did a resume and
12 I direct them to read it at such time as they wish to,
13 particularly before they take exams.
14 MR GARNHAM: You will also be familiar with the District
15 Child Protection Policy, volume 39, page 129.
16 DR ROSSITER: That is the ACPC one?
17 MR GARNHAM: Haringey Health Care NHS Trust, District Child
18 Protection Policy of June 1996 or 1995. Do you have
19 that document?
20 DR ROSSITER: Yes.
21 MR GARNHAM: Was that still current at the time we are
22 concerned with?
23 DR ROSSITER: I believe there is a 1997 one. I have been
24 looking at some pages from it recently.
25 MR GARNHAM: That may well be my mistake and we will check
120
1 that over lunch and come back to it but there is such
2 a District Child Protection Policy in existence?
3 DR ROSSITER: Not only that but I was part of the writing of
4 it in conjunction with a designated nurse.
5 I contributed pages to deal with health. I would have
6 contributed the pages for the health sections. That is
7 why I believe that the sections that we have in our
8 North Middlesex guidelines are the same or similar to
9 those in the ACPC guidelines, the only difference being
10 that we have been updating ours every 18 months or so,
11 whereas the ACPC ones may not be updated quite as
12 recently.
13 MR GARNHAM: These guidelines are for the benefit of people
14 like health visitors and GPs?
15 DR ROSSITER: They are available to be referred to.
16 MR GARNHAM: I am trying to understand how these various
17 guidelines mesh together.
18 DR ROSSITER: There are separate district health guidelines.
19 I think you will find that Mrs Liz Fletcher can tell you
20 about that because she is responsible for the sections
21 that have been used for the community that overlap.
22 MR GARNHAM: And will she be the person I should ask about
23 the process of distribution of that document?
24 DR ROSSITER: I hope she will forgive me, but yes.
25 MR GARNHAM: In volume 40 at 163, please, we have the
121
1 registrar's training prospectus.
2 DR ROSSITER: Yes.
3 MR GARNHAM: I imagine that we are back on more familiar
4 territory.
5 DR ROSSITER: Well I am not the author of it but I am
6 familiar with it.
7 MR GARNHAM: What is the process by which you ensure that
8 registrars get child protection training?
9 DR ROSSITER: They are required to come to our annual
10 course. We run this two-day multidisciplinary, it is
11 multidisciplinary but for health staff, every March, and
12 we instruct our registrars that they should come and we
13 make provision that they can have leave and that there
14 is a budget which Dr Alsford somehow manages do at the
15 last minute so that all our trainees can come to it, it
16 is a requirement of their training. And I think you
17 have seen the content of that course. It has been
18 submitted.
19 MR GARNHAM: Thank you. Next rung down the ladder, page 166
20 we have the SHO training prospectus.
21 DR ROSSITER: It is very similar. The only problem is that
22 some of the SHOs are only with us six months.
23 MR GARNHAM: What training do they get?
24 DR ROSSITER: They are invited to come back to the meeting
25 after they have left us if they so wish at the lower
122
1 price. They too get the initial induction and then they
2 get feedback on ward as an apprenticeship. What they do
3 not get, what they could do which they very sadly do not
4 often get, is to many come to our NAI meetings on
5 Tuesday. They are invited. So they do not get a lot of
6 feedback about what happens to patients later. Nor do
7 they get in-depth training on what to do after they
8 have done their documentation.
9 MR GARNHAM: But those deficiencies do not apply to the
10 registrars, I imagine?
11 DR ROSSITER: No.
12 MR GARNHAM: They do go to the Tuesday meetings?
13 DR ROSSITER: They do not very often, they should do. If
14 I can go back a stage, it is laid out very clearly in
15 responsibility that SHOs do documentation and that their
16 work has to be countersigned. I feel that any senior
17 house officer is capable of taking a history and
18 documenting but the decision about what to do has to be
19 made by a registrar or a consultant. That is spelt out
20 to them very carefully and indeed if you look in the
21 section I guidelines under "Communication" and also
22 under "Medical Examination", it points out that they are
23 a witness to fact, they are not an expert witness.
24 MR GARNHAM: A theme that runs through all these training
25 manuals and guidelines is the importance in child
123
1 protection cases of making an accurate record of what is
2 observed.
3 DR ROSSITER: Yes.
4 MR GARNHAM: Would you say the same applies in respect of
5 what is suspected?
6 DR ROSSITER: What we tell our doctors to do is to be
7 objective. We tell them when taking a history not to
8 ask leading questions or to cross-examine because we
9 feel that that will interfere with further interrogation
10 that might be done by the police should there be
11 a criminal inquiry. Similarly we tell them not to
12 write, if there are bruises, "old bruise" or "new
13 bruise". We ask them to write down what it looks like,
14 to document the colour and to measure it. Because
15 otherwise if you make an inaccurate judgment, when you
16 then go to court you get cross-examined, it does not
17 help the child, and this happens.
18 MR GARNHAM: But in respect of events that occur say in
19 relation to the relationship between a child and its
20 parents, you would expect your staff to make a note of
21 the objective events that they see?
22 DR ROSSITER: I certainly would because if you look at CP3
23 you will see that there are lines left there for the
24 doctor to make an observation. So that highlights that
25 we find it important.
124
1 MR GARNHAM: If a doctor or a nurse was suspicious because
2 of the facts they had observed and heard, that an injury
3 might have been caused deliberately, what would they do
4 about that?
5 DR ROSSITER: Could you rephrase that?
6 MR GARNHAM: If a nurse or doctor suspected that an injury
7 might have been caused as a result of the deliberate
8 infliction by an adult, what ought they do about that
9 thought?
10 DR ROSSITER: They would complete the CP forms if they had
11 not done so already and they would share the thought.
12 The forum for sharing those thoughts is the Monday
13 meeting because that is when we have sufficient people
14 to listen.
15 MR GARNHAM: Would you not expect the doctor or the nurse
16 compiling the record as they go to make a note if they
17 suspect it, if there was abuse?
18 DR ROSSITER: Yes I would expect it, yes, and this was
19 deficient in this case and we are aware of it and we are
20 doing our best now.
21 MR GARNHAM: I understand that but it matters nonetheless
22 that we understand how it was being dealt with. Your
23 evidence is that there ought to be recorded in the
24 history or on the CP forms doctor and nurses' suspicions
25 that a child was the victim of abuse, even if that is
125
1 not an observable fact.
2 DR ROSSITER: I think it comes down to the tick of whether
3 this was abuse or not.
4 MR GARNHAM: The tick?
5 DR ROSSITER: The three things they have to decide at the
6 bottom of CP3.
7 MR GARNHAM: Yes.
8 DR ROSSITER: It is not as clear as it might be on the
9 version that was used when Victoria was with us and
10 I think that you may have seen the updated version.
11 What I say to them is that they must decide on the
12 balance of probability and the information that they
13 have now whether this is likely to be child abuse or
14 whether it is likely not to be child abuse or whether in
15 all honesty they need more information before they can
16 make a decision.
17 I tell them that they will not necessarily be held
18 to that decision subsequently if there is further
19 information, but we need that information so that our
20 colleagues in social services know whether the child
21 needs to be in safety or further investigated, so that
22 is an initial decision about the child's safety.
23 MR GARNHAM: We had better have a look at that form. Could
24 you have volume 37 please, page 55. This happens to be
25 the form completed in respect of Victoria but I am
126
1 interested for the moment in the generality and the
2 completion of this form. This is the tick boxes that
3 you were referring to?
4 DR ROSSITER: Yes.
5 MR GARNHAM: Where the conclusions are three in number and
6 the doctor chooses between them?
7 DR ROSSITER: Yes, I encourage them not to use the third
8 option unless they can help it.
9 MR GARNHAM: Are you describing the position as it was in
10 1999 at the moment?
11 DR ROSSITER: No, it was how it was then. Yes, I am
12 describing how it was in 1999. All I have done since
13 then is to clarify it.
14 MR GARNHAM: Yes. That amounts to a partial answer to my
15 original question which was whether doctors and nurses
16 should record their suspicions and I can see that you
17 say that that box is the obvious place where suspicions
18 might be recorded by means of a tick.
19 DR ROSSITER: Yes.
20 MR GARNHAM: But are doctors and nurses expected in addition
21 to record thoughts indicating a suspicion that has
22 arisen in their mind as a result of the history they
23 have taken?
24 DR ROSSITER: It is a spectrum of how firm they feel in
25 their thoughts. I am thinking of an occasion, again it
127
1 is sexual abuse, where a male doctor felt that a child
2 had approached his flies in a rather inappropriate
3 manner and he was embarrassed.
4 MR GARNHAM: You mean there is an appropriate manner in
5 which a child --
6 DR ROSSITER: Well indeed. Then he said, "Am I imagining
7 this? Was it just me? I do not feel I can write this
8 down." But it was actually an incredibly important
9 observation. So he told me this but we did not write it
10 down but we used it as a basis for thinking of other
11 ways to get this information.
12 MR GARNHAM: I think I take from your evidence therefore
13 that you do not expect doctors to record on the CP forms
14 thoughts they have arising from the history they have
15 received that there is a suspicion of child abuse?
16 DR ROSSITER: The fact that CP forms are filled in means
17 that the suspicion has arisen, otherwise they would be
18 using the clinical notes, but the tick box, the three
19 decisions at the bottom, would be the conclusion that
20 this doctor came to by the time they had finished doing
21 that.
22 MR GARNHAM: Once a case has been referred to the paediatric
23 team using these forms as a possible child abuse case,
24 forms CP1 to 5 are then completed?
25 DR ROSSITER: CP5 is not always completed to my
128
1 satisfaction. It is what you might call a teaching
2 point and it was bearing that in mind that I took
3 a particular point of completing it with Dr Forlee on
4 the Sunday morning.
5 MR GARNHAM: That is in respect of Victoria's case?
6 DR ROSSITER: In respect to Victoria.
7 MR GARNHAM: As we are presently discussing the generality,
8 what should happen is that CP1, 2, 3, 4 and 5 should be
9 completed?
10 DR ROSSITER: 1 to 3 plus 5 by the doctors.
11 MR GARNHAM: What is 4?
12 DR ROSSITER: It is the nurse's one for transfer from A&E to
13 the ward.
14 MR GARNHAM: Have you discovered that in this, in the papers
15 we have for Victoria?
16 DR ROSSITER: I do not recall seeing it, no.
17 MR GARNHAM: So there ought to be, I confess that I had
18 assumed that the map we have at page 56 in that bundle,
19 which falls between CP3 and CP5, was CP4 but I am
20 obviously wrong about that.
21 DR ROSSITER: Do you mean the diagram?
22 MR GARNHAM: Yes, 37, page 55, CP3, 55, volume 37.
23 DR ROSSITER: I have got that, 37/055, over there, that is
24 Dr Forlee's picture.
25 MR GARNHAM: That is not an example of a CP4?
129
1 DR ROSSITER: No.
2 MR GARNHAM: It is just chance it happens to fall between
3 CP3 and CP5?
4 DR ROSSITER: It would not normally be filed there.
5 MR GARNHAM: You understand my confusion but I am grateful
6 for the correction. CP4 is a form used by nursing
7 staff?
8 DR ROSSITER: Yes and then the diagrams would probably --
9 you would probably have CP1 to 3, CP4, all the diagrams
10 and then conclude with CP5 which is the decision-making
11 document.
12 MR GARNHAM: Let me ask you about CP4 first of all. CP4,
13 you have not seen one in respect of Victoria?
14 DR ROSSITER: I do not recall it.
15 MR GARNHAM: Should there have been one?
16 DR ROSSITER: As a routine it should, yes. Whether it would
17 have benefited I do not know but yes it should have
18 been.
19 MR GARNHAM: On that form nurses should record their child
20 protection concerns, should they?
21 DR ROSSITER: Yes, and it particularly has items of
22 relationships between the child and parent. I have not
23 thought it through in as much detail as the others
24 because I teach the doctors how to fill in the doctors'
25 forms but I believe that it does particularly ask about
130
1 interrelationships and reactions.
2 MR GARNHAM: Before I come back and explore what happened to
3 CP4 in this case in more detail, can I make sure
4 I understand what CP6 is?
5 DR ROSSITER: CP6 really was not happening at that time. It
6 was supposed to happen but by default it never did.
7 MR GARNHAM: What should it be?
8 DR ROSSITER: What it should be is for further concerns in
9 the hospital. What it now is is exactly that.
10 MR GARNHAM: So there ought to be a CP4 for nurses' further
11 concerns and a CP6 for other people's further concerns?
12 DR ROSSITER: CP6 is for what goes on next. CP1 to 5 or at
13 least 1 to 4 is the initial admission and then CP6 is
14 where you record subsequent observations or subsequent
15 occurrences.
16 MR GARNHAM: So 1 to 4 are historical?
17 DR ROSSITER: Yes.
18 MR GARNHAM: 6 is future looking?
19 DR ROSSITER: Yes.
20 MR GARNHAM: And we do not have either CP4 or CP6 in this
21 case?
22 DR ROSSITER: Well, we were not using CP6 I am afraid.
23 MR GARNHAM: But the answer to my question is still yes, we
24 do not appear to have either of those in this case?
25 DR ROSSITER: No, we do not.
131
1 MR GARNHAM: If neither CP4 nor CP6 are in use in
2 a particular case and a child is admitted to an
3 in-patient ward, where are those continuing concerns
4 recorded?
5 DR ROSSITER: As you have seen already in parallel the
6 things that are felt to be clinical are written down by
7 doctors and nurses in the clinical notes. The concerns
8 about nurses are in their critical incident log and I am
9 afraid the doctors do not have anywhere very much in
10 particular but I would expect them to do it in their
11 clinical day by day notes. I know this because we make
12 a point that we do not use our end of the bed notes on
13 the end of the bed if there are confidentiality or child
14 protection issues. That is part of the instructions.
15 So the place I would expect it -- I am thinking on my
16 feet -- where I would expect it to be would be in the
17 continuation notes talking about the child's clinical
18 care.
19 MR GARNHAM: I want to understand where these documents are
20 kept.
21 DR ROSSITER: In the trolley.
22 MR GARNHAM: The clinical multidisciplinary notes?
23 DR ROSSITER: Yes.
24 MR GARNHAM: And the CP forms are kept in the ward trolley?
25 DR ROSSITER: Yes, they should be in separate folders in the
132
1 same slot. Whether they were or not, as far as
2 Victoria's case is concerned, I have no idea.
3 MR GARNHAM: Beatrice Norman talked about the legal file in
4 the note trolley. Is that the same thing?
5 DR ROSSITER: I think we are saying the same thing.
6 MR GARNHAM: So there are notes, clinical notes kept on the
7 foot of the bed?
8 DR ROSSITER: Except if there are child protection concerns,
9 in which case they too are kept in the trolley.
10 MR GARNHAM: Then they are kept in a trolley that contains
11 notes?
12 DR ROSSITER: And that goes on the ward round.
13 MR GARNHAM: Which follows the doctor round?
14 DR ROSSITER: Doctor and nurse.
15 MR GARNHAM: And in there there are legal files which
16 contain the CP material?
17 DR ROSSITER: Yes.
18 MR GARNHAM: And what else, the critical incident log?
19 DR ROSSITER: No.
20 MR GARNHAM: Where is that?
21 DR ROSSITER: Well, it is the responsibility of the nurses,
22 so whatever Beatrice Norman said she is the one who
23 knows. It has not been my responsibility.
24 MR GARNHAM: I want to understand how people who want to see
25 this material gain access to it. If you are conducting
133
1 a ward round you can look at the notes in the bottom of
2 a bed. In a case like Victoria that would not tell you
3 very much.
4 DR ROSSITER: I would turn to the nurse who was with us and
5 ask her.
6 MR GARNHAM: She would provide you with what?
7 DR ROSSITER: She would provide me with the information that
8 she had.
9 MR GARNHAM: She would provide you with the CP forms, with
10 the critical incident log?
11 DR ROSSITER: I would expect that she would refer to the
12 critical incident log. Yes, because that is that is the
13 information that she had.
14 MR GARNHAM: I want to come back to the question of in-house
15 and out of house meetings. I have been provided with
16 a document this morning which may be relevant to that
17 which I have not read so I will return to that after the
18 lunch break if I may.
19 DR ROSSITER: Yes.
20 MR GARNHAM: Let me for the moment turn to the fact of
21 Victoria's case.
22 DR ROSSITER: Yes.
23 MR GARNHAM: You say you were the on-call consultant on
24 Sunday 25th July.
25 DR ROSSITER: I believe I was also on from about 9 o'clock
134
1 on the Saturday evening. That is in that timetable that
2 we can provide you with of what I was doing. On the
3 timetable it was Dr Meates but for various reasons
4 I owed her and I had said that I would take the evening
5 and the Sunday, and I believe that that was from
6 9 o'clock on the Saturday.
7 MR GARNHAM: 9 o'clock in the evening?
8 DR ROSSITER: Yes I think so.
9 MR GARNHAM: So although we see from the paediatric rota
10 document that she is down as being the on-call
11 consultant, you in fact were from 9 o'clock on the
12 Saturday evening?
13 DR ROSSITER: I have checked my diary. I had my diaries for
14 that time.
15 MR GARNHAM: That would confirm it, would it?
16 DR ROSSITER: That is what I have got written in, that is
17 why I have been able to put in quite a lot of the
18 appointments that I was doing.
19 MR GARNHAM: So Dr Forlee may well be correct then when she
20 says she spoke to you that Saturday evening?
21 DR ROSSITER: I think it is highly likely, yes.
22 MR GARNHAM: Certainly you appear to have signed CP5 which
23 is at page 57 in that bundle.
24 DR ROSSITER: Yes. I have not signed it, I have annotated
25 it. I actually signed CP3.
135
1 MR GARNHAM: But if we see "consultant paediatrician" in the
2 second box, "Dr Rossiter", someone has written "yes" and
3 then there is the date.
4 DR ROSSITER: The date is my handwriting and also on CP1,
5 where it says "Consultant: Rossiter", I have put that.
6 So it should have been entirely clear that the case was
7 my responsibility.
8 MR GARNHAM: And that you were informed about it on
9 24th July, the Saturday?
10 DR ROSSITER: Yes.
11 MR GARNHAM: Dr Forlee told us that she was unable to
12 complete a full examination of Victoria in A&E on that
13 Saturday evening.
14 DR ROSSITER: Yes.
15 MR GARNHAM: Would you have expected her to do that?
16 DR ROSSITER: If the child was distressed and she was not
17 able to do so I would have expected that she would have
18 asked me what to do and I would have expected that
19 I would have said, "Well, if it is late and the child --
20 we are admitting the child anyway, let us deal with what
21 we need to do, which is to treat the burns and to inform
22 the duty social worker that the case is in and then we
23 will take it further tomorrow.
24 MR GARNHAM: That is what you would have expected to happen.
25 Do you have any recollection of what did happen?
136
1 DR ROSSITER: None whatsoever.
2 MR GARNHAM: So is this the position, that normally the A&E
3 SHO would conduct an examination?
4 DR ROSSITER: Yes.
5 MR GARNHAM: But it would not surprise you in circumstances
6 such as this if it was left to the following morning?
7 DR ROSSITER: No.
8 MR GARNHAM: No, you are agreeing with me?
9 DR ROSSITER: I am agreeing with you.
10 MR GARNHAM: If, as appears to have happened in this case,
11 the SHO only does a cursory examination of the patient
12 on the night of admission, presumably there should be
13 a full examination the following morning?
14 DR ROSSITER: Yes.
15 MR GARNHAM: Because it is essential, is it not, that at an
16 early stage a complete record is made of the state of
17 the child?
18 DR ROSSITER: Yes.
19 MR GARNHAM: You have told us that the inclusion of your
20 name on CP1 means that you are the consultant taking
21 responsibility for this case.
22 DR ROSSITER: Yes.
23 MR GARNHAM: You saw Victoria the following morning.
24 DR ROSSITER: The circumstances in which I saw Victoria the
25 following morning are very difficult to remember. I am
137
1 having great difficulty in knowing what I am sure about,
2 what I think I remember and what I wish I remember. So
3 I have to be guided by others from whom you have or will
4 be hearing evidence. I know I saw her. I think
5 I remember seeing her in the bath or I may have seen her
6 in a towel. I do not believe that I actually saw her as
7 a patient lying on a bed.
8 MR GARNHAM: Given that there had not been a full
9 examination of Victoria by Dr Forlee the previous
10 evening, was it not essential that there was such a full
11 examination the following morning on the ward?
12 DR ROSSITER: Yes, I would expect that to be done by either
13 the same SHO before she went off or by the new SHO
14 coming on.
15 MR GARNHAM: It does not appear to have happened, does it?
16 DR ROSSITER: No.
17 MR GARNHAM: Why on earth not?
18 DR ROSSITER: I do not know. I know that I wanted it to
19 happen. I can recall looking at the marks and saying to
20 someone, "This needs to be documented", but I regret
21 that I have not recorded what I said or to whom but I do
22 know that I had an expectation that it would be fully
23 documented.
24 MR GARNHAM: That is a slightly different point, is it not
25 Dr Rossiter, because what I am asking at the moment is
138
1 not whether your observations were documented but
2 whether anybody ever carried out that day a proper
3 examination of Victoria.
4 DR ROSSITER: I had thought, and actually it was only quite
5 recently that I realised that Dr Reynders' examination
6 was done on the Monday. I truly believed it had been
7 done on the Sunday and it was only when preparing for
8 this Inquiry that I realised that it had the Monday date
9 on. It could have been at the time of the trial.
10 Certainly it was after her discharge that I was aware it
11 was a day late.
12 MR GARNHAM: I can understand I think why it is that the SHO
13 may not conduct a full examination on the evening of
14 admission but you have told us that it was essential
15 that at an early stage a full examination is carried
16 out.
17 DR ROSSITER: And I had believed that it had been.
18 MR GARNHAM: Where has the failure occurred? Why is it we
19 get through the whole of the next day with nobody doing
20 a full examination of this girl?
21 DR ROSSITER: I do not know.
22 MR GARNHAM: But that is what appears to have happened.
23 DR ROSSITER: It is.
24 MR GARNHAM: With the result that nobody had a
25 contemporaneous record of the girl's condition at the
139
1 time of admission.
2 DR ROSSITER: True.
3 MR GARNHAM: Which could have been disastrous in a criminal
4 trial because it might have been open to a carer to say
5 she was not in that condition when she went into
6 hospital. It must have happened there.
7 DR ROSSITER: That was why we had CP6 originally. No, that
8 is -- no that is not the answer to the question, you are
9 quite right. It would have made us liable.
10 MR GARNHAM: Were you aware at the time you first had
11 contact with Victoria's case, in other words in the
12 telephone conversation on the 24th, were you aware of
13 the fact that Victoria had been admitted to the CMH a
14 fortnight earlier?
15 DR ROSSITER: I cannot remember.
16 MR GARNHAM: Do you recall when you first became -- you did
17 eventually become aware of that fact?
18 DR ROSSITER: Yes.
19 MR GARNHAM: Do you recall when you first became aware of
20 it?
21 DR ROSSITER: No.
22 MR GARNHAM: Do you recall whether you ever got the notes
23 from the CMH?
24 DR ROSSITER: I did not send for them. I did not find it
25 necessary to send for them. I knew she had been there
140
1 because that was recorded on the CP forms, but getting
2 the notes, I think that I was faxed their records in the
3 autumn. I think that Petra Kitchman sent them to me.
4 MR GARNHAM: I do not understand that. If you have a child
5 about whom there were child protection concerns as
6 a patient and you know that she had been in another
7 hospital two weeks earlier, would it not be elementary
8 to see what happened to lead to that previous admission?
9 DR ROSSITER: It would eventually but as far as we were
10 concerned we wanted to make decisions about whether the
11 child was safe, whether she needed to be reported to
12 social services. So if I could give you an example that
13 if, for instance, I had a child coming in with an
14 illness which seemed unusual but had no injuries, then
15 I would, and I do, and I have made intensive enquiries
16 of other hospitals to look at the medical aspects of it
17 to say, "Well, this looks like for instance a case of
18 factitious disease by proxy". However, the fact that we
19 had a girl who had got physical injuries and also most
20 extraordinary management of a burn, however it had
21 occurred, amounting to neglect, said to me that we had
22 perfectly enough information here to make the referral
23 to social services.
24 MR GARNHAM: But you might find there were even more gold
25 nuggets in the CMH files that could have been usefully
141
1 referred.
2 DR ROSSITER: And I would be expecting to be shown those by
3 the lead agency who was making the enquiries. If you
4 look at the ACPC instructions about an enquiry it says
5 that the lead agency will get information from everybody
6 else, including doctors, so having once made the
7 referral my expectation was that the collection of
8 information would be made by the lead agency of the
9 Section 47 and that then would be presented to me for
10 comment.
11 MR GARNHAM: Was there not a clinical need to know what had
12 happened to Victoria on her previous admission to
13 hospital?
14 DR ROSSITER: No, the scabies was irrelevant. She had had
15 scabies, it had been treated. Here she was with
16 a completely different set of circumstances.
17 MR GARNHAM: As it turned out she may well have had a good
18 deal more in addition to scabies.
19 DR ROSSITER: Indeed.
20 MR GARNHAM: But you did not know about that because you did
21 not have the CMH notes.
22 DR ROSSITER: I do not think that that would have come to me
23 with or without the CMH notes. It was the dermatologist
24 who pointed it out. We knew it was something unusual
25 and that is why we asked for a dermatological opinion.
142
1 MR GARNHAM: But just as we talked earlier about the
2 parallels between child abuse and other disease
3 processes, if this was another disease you would have
4 obtained the previous notes, would you not?
5 DR ROSSITER: Not routinely. I will usually inform another
6 hospital as a matter of courtesy if I have seen their
7 patient. If I need something for previous x-rays and
8 things I will enquire. I do believe that I do this more
9 than quite a lot of my colleagues. I know that I have
10 a bad reputation with the secretaries and the junior
11 doctors for making their life very difficult for so
12 doing.
13 MR GARNHAM: I imagine it follows from what you have already
14 said but you did not speak to a doctor at CMH either.
15 DR ROSSITER: There was no reason to, it seemed to me at the
16 time.
17 MR GARNHAM: It means, does it not, that you were not aware
18 of the child protection concerns that there had been at
19 CMH at the time you were considering the child
20 protection concerns at NMH?
21 DR ROSSITER: I already knew that I was concerned about the
22 girl. Clearly if I had had that information it would
23 have heightened my concern and had I been at a strategy
24 meeting or a case conference I would certainly have
25 commented as I did in court that marks that were found
143
1 two weeks previously and scabies were a separate issue
2 from the marks that we found.
3 MR GARNHAM: Sir, would that be a convenient moment?
4 THE CHAIRMAN: I am grateful to you. Ladies and gentlemen
5 we will break until 2.15 when we will resume.
6 Dr Rossiter, you are under oath and you are not allowed
7 to discuss your evidence with anyone else. That
8 includes your colleagues and your advocate.
9 (1.30 pm)
10 (The short adjournment)
11 (2.15 pm)
12 MR GARNHAM: Could we have Dr Rossiter back please.
13 Dr Rossiter, the child protection form appears to be
14 the means for conveying information --
15 DR ROSSITER: Yes.
16 MR GARNHAM: -- from the hospital to social services.
17 DR ROSSITER: Yes.
18 MR GARNHAM: What training is given, first of all, to
19 nursing staff and doctors as to the use to which that
20 form is to be put?
21 DR ROSSITER: The training is mainly for doctors because it
22 is the doctors who fill it in.
23 MR GARNHAM: Apart from those who have seen it before?
24 DR ROSSITER: Yes, I apologise.
25 MR GARNHAM: So what training is given first of all to
144
1 doctors?
2 DR ROSSITER: As far as the doctors are concerned they get
3 it at induction. I have an hour for induction for child
4 protection procedures and obviously you cannot get a lot
5 in in an hour so I put a considerable amount of emphasis
6 in filling in the forms partly for motivation because
7 they hate doing it.
8 MR GARNHAM: They know that is the mechanism by which the
9 information will travel from the hospital to the social
10 services?
11 DR ROSSITER: Very much so. I explained to them that it is
12 a legal document. In fact it says so at the top of CP1
13 and if they fill it in properly I can use it in evidence
14 and that is their reward, not having to go to court.
15 MR GARNHAM: The same instruction to nurses, or do you not
16 know?
17 DR ROSSITER: Well, the nurses would not usually -- I do not
18 do the induction for the nurses, however all the CP
19 forms are explained at our annual two day conference.
20 I do an hour on the medical examination and filling in
21 forms and things and there is usually a pretty good
22 nurse representation there as well.
23 MR GARNHAM: What about the agencies who receive these
24 forms, particularly social services? What instructions
25 do they get about what they should expect in the CP
145
1 forms?
2 DR ROSSITER: There is not an official way of doing it but
3 it comes out of teaching. There is the three times
4 a year five day course which is multi-disciplinary and
5 I do two lectures on. That one is what is child abuse
6 which is a slide show, and the other is medical
7 examination, prerequisite, et cetera.
8 MR GARNHAM: Are they told that this will be the means by
9 which they are informed of the hospital's child abuse
10 concerns?
11 DR ROSSITER: I cannot think of a mechanism by which I say
12 to everyone it is. I know it sounds silly but we have
13 always done it this way and we have used it with our
14 colleagues in both Enfield and Haringey for a very long
15 time and they routinely get it. So, it has happened.
16 It has grown up as a method that we use.
17 MR GARNHAM: Is your experience of using it such that you
18 think social services understand what it is you are
19 using it for?
20 DR ROSSITER: Yes.
21 MR GARNHAM: I was asking you about the legal file, as it
22 has once been called. I wonder if you could look at the
23 legal file in Victoria's case just to help me with
24 something on the cover sheet. Volume 37, page 48.
25 I was trying to understand where these documents were
146
1 kept and how people had access to them. It has been
2 pointed out to me that at the foot of that page in
3 handwriting there is annotated the words "Keep on
4 Keats". Do you have any idea of what that means?
5 DR ROSSITER: Yes, it is our children's out-patients and
6 secretariat and offices.
7 MR GARNHAM: Do you know when that endorsement would have
8 been added? Is this how it would have been at the time
9 when Victoria was a patient or has this been added some
10 time subsequent to that?
11 DR ROSSITER: I do not know.
12 MR GARNHAM: It would be odd to keep this legal file in that
13 place while she was there.
14 DR ROSSITER: In my statement it explains that we keep the
15 child protection forms in on the ward until the child is
16 discharged.
17 MR GARNHAM: Yes.
18 DR ROSSITER: After discharge the two sets of notes are
19 filed separately. The clinical notes go back to the
20 hospital filing and the legal notes come back to Keats.
21 MR GARNHAM: That is the explanation, thank you.
22 I said I would come back to arrangements for
23 meetings and I have asked for some documents that I was
24 supplied with shortly before we broke to be photocopied.
25 They are not yet here but let me ask you some questions
147
1 about that, if I may. You described this morning in
2 answer to my questions the discussion that went on
3 between you and social services whether strategy group
4 meetings should be held in hospital or not and I, rather
5 putting words into your mouth, suggested that subsequent
6 to Victoria's case that was a battle that you had won.
7 Do you recall that exchange?
8 DR ROSSITER: Yes.
9 MR GARNHAM: That was perhaps unfair, was it not, because
10 the battle had already been won long before that? Can
11 you be shown volume 24, please, page 31. Sorry, we
12 ought to look at the beginning of the document. Page 1.
13 This is Haringey's Child Protection Guidelines and can
14 I ask to you turn in that document to page 31, please.
15 In paragraph 2.1, under the heading "Steps to be taken
16 in respect of a strategy meeting" --
17 DR ROSSITER: I think I am having difficulty with the pages.
18 MR GARNHAM: Are you? Page 31.
19 DR ROSSITER: I have 24/031 against page 31 -- that 31.
20 I am so sorry. Yes.
21 MR GARNHAM: 24/031.
22 DR ROSSITER: Yes, I do apologise.
23 MR GARNHAM: Not at all.
24 "2.1. Steps to be taken in respect of a strategy
25 meeting. Set up the strategy meeting on the same day of
148
1 receipt of the referral."
2 This is instructions to Haringey Social Services.
3 Three sentences later:
4 "In the event of the child being in hospital the
5 meeting must be held at the hospital."
6 DR ROSSITER: Well I am very grateful to you for that
7 because I -- it is so long ago since I had seen it that
8 I could not remember where I had seen it. I can
9 remember occasions thinking I have to make a fuss, we
10 need to have the strategy meeting in the hospital. Then
11 when I looked in our own guidelines I could not find it
12 specified there and I felt, therefore, I did not have
13 the strength to insist.
14 MR GARNHAM: But it looks as if it has already been decided.
15 DR ROSSITER: It has been decided but it was not happening.
16 MR GARNHAM: But you could have insisted, had you got this
17 at your fingertips, that there be compliance with this
18 paragraph of Haringey's own internal guidance?
19 DR ROSSITER: Indeed.
20 MR GARNHAM: Similarly, I asked you about you calling for
21 a case conference.
22 DR ROSSITER: Yes.
23 MR GARNHAM: I wonder if you could look in the same volume,
24 please, to page 452. We ought to identify the document
25 by going to page 450, first of all.
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1 DR ROSSITER: Yes.
2 MR GARNHAM: We will see that that is chapter 11, and it is
3 chapter 11 of the Haringey ACPC Child Protection
4 Procedures Handbook.
5 DR ROSSITER: Yes.
6 MR GARNHAM: Go on then to the page I gave you, 452. You
7 will see, third paragraph from the top, these words:
8 "The decision not to convene a case conference
9 following a child abuse referral investigation should be
10 discussed by the social worker and team leader after
11 consultation with the child protection team, there
12 referrer and other investigative agencies involved."
13 DR ROSSITER: Yes.
14 MR GARNHAM: I suspect "there" should be the other spelling
15 but it seems to be apparent from that paragraph that as
16 soon as there has been a child abuse referral there
17 ought, in the ordinary course, automatically to be
18 a case conference, and that if there is not, a positive
19 decision to that effect has to be taken in the manner
20 described in that paragraph.
21 DR ROSSITER: Yes.
22 MR GARNHAM: It may be that others are able to give evidence
23 to contrary effect but that would be your reading of
24 that paragraph, would it?
25 DR ROSSITER: Yes, and hence my expectation that a case
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1 conference would occur.
2 MR GARNHAM: Was it normal practice, during 1999, that if
3 there was no case conference following a referral of
4 a child abuse case to social services, that that would
5 be discussed if that was a proposal?
6 DR ROSSITER: I am having difficulty in knowing what
7 happened and what it felt as if it happened. I had
8 a sort of feeling of despair at times that I did not
9 know |
