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Archived Transcript for 12 November 2001: Pages
151 to 200
151
1 MR GARNHAM: Did that happen in practice in 1999?
2 DR ROSSITER: Without an audit, I would not be able to tell
3 you that, but it feels as if it did not.
4 MR GARNHAM: Your role, if it does not, is to recommend that
5 there should be a conference?
6 DR ROSSITER: Yes.
7 MR GARNHAM: If you make such a recommendation, the
8 overwhelming likelihood is that it would be accepted, is
9 it not?
10 DR ROSSITER: It depends how much effort I put into it.
11 MR GARNHAM: I am going to have to ask you to explain that
12 a little more. If you simply right write to social
13 services or telephone social services and say,
14 "I recommend a case conference in this case", does more
15 need to be done than that?
16 DR ROSSITER: Often.
17 MR GARNHAM: What more often needed to be done?
18 DR ROSSITER: Phone calls, badgering, letters. I have had
19 to do this quite a bit this year. With reasonably
20 positive results, but it has been quite hard work.
21 MR GARNHAM: Thank you. Next; in relation to these
22 meetings, I wonder if you could be passed a copy of the
23 document that I told you I was given this morning.
24 Sir, this document has now been given an index
25 reference and has been circulated to the parties. It
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1 comes to us through I think it is either Enfield Council
2 or Miss John personally. It consists first of all of
3 minutes of a meeting of paediatric social workers and
4 consultant paediatricians in December 1997.
5 DR ROSSITER: Yes.
6 MR GARNHAM: You were at that meeting?
7 DR ROSSITER: Yes.
8 MR GARNHAM: Do you recall that meeting?
9 DR ROSSITER: I do. And I can recall that there was
10 a stance made by Dr Naidoo and myself particularly not
11 necessarily agreeing with our colleagues in the hospital
12 social work department.
13 MR GARNHAM: This concerns Monday ward meetings?
14 DR ROSSITER: Yes.
15 MR GARNHAM: Those are psychosocial meetings that we have
16 heard talk about?
17 DR ROSSITER: Yes.
18 MR GARNHAM: It is said in the first paragraph at the end:
19 "It was felt by the consultants that the absence of
20 social workers from these Monday meetings made matters
21 worse and communications more difficult."
22 DR ROSSITER: Yes.
23 MR GARNHAM: Then we see, towards the end of the next
24 paragraph:
25 "Consultants stated that Haringey children do not
153
1 get access to the same resources as Enfield children ...
2 again it was stated the remit which Enfield social
3 workers hold re out of our clients."
4 DR ROSSITER: Yes.
5 MR GARNHAM: Tell us what the effect of that meeting was.
6 DR ROSSITER: Not a lot changed, as far as I can remember.
7 MR GARNHAM: Sorry, I phrased it poorly. What point of view
8 did you put forward at that meeting?
9 DR ROSSITER: We put forward the view that we found those
10 meetings invaluable because we thought it was important
11 to share information prior to an official referral. The
12 response we got was it was felt that they were not on an
13 official enough basis, that they were not chaired and
14 minuted sufficiently, and I think you would agree with
15 that, and that the social workers wanted to have
16 referrals made to them as a referral, using this new
17 form which Mrs Cynthia Lipworth launched, and they felt
18 that having preliminary discussions and sharing
19 information, the sort of things we have discussed
20 earlier you cannot always put in writing, was not good
21 use of their time.
22 MR GARNHAM: Was the result of that meeting, first meeting,
23 that social workers attended these Monday afternoon
24 meetings?
25 DR ROSSITER: I do not think so. As I recall, the social
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1 workers kept their stance that it was not useful use of
2 their time and that we should continue to fill in our
3 referral forms accurately, after which the information
4 would be put on a computer and it would be decided by,
5 I think, the I and A team that -- which social worker
6 would be allocated to us.
7 MR GARNHAM: Further on in that little bundle there is the
8 meeting of social workers and consultants on
9 17th December. Two pages further on, it is 237 at the
10 bottom.
11 DR ROSSITER: "Clarity about what referral social workers
12 will take or consider"?
13 MR GARNHAM: Yes, only I would like you to look at the top
14 of that page, minutes of a meeting on that date.
15 "Attendance of social workers at ward meetings on
16 Mondays. Consultants have stated ..." -- do you have
17 this?
18 DR ROSSITER: I have. I am in distinct difficulty here
19 because I have made a pledge that I am not going to make
20 any personal remarks about any person in another agency,
21 but there are reasons why this remark was made and
22 I think it may become apparent in Karen Johns' evidence,
23 because I have seen her statement.
24 MR GARNHAM: I am afraid I might not be able to go along
25 with that entirely, Dr Rossiter. Can I ask you first of
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1 all to deal with what we see on the face of the
2 document.
3 DR ROSSITER: May I say that there were reasons why the
4 social workers who attended had a different perception
5 of the meetings than the rest of us.
6 MR GARNHAM: Let us make sure we know what meetings we are
7 talking about.
8 DR ROSSITER: The Monday ones.
9 MR GARNHAM: Is it right, first of all, that there was
10 a meeting on 17th December?
11 DR ROSSITER: I am sure, yes. It is documented.
12 MR GARNHAM: Did you attend?
13 DR ROSSITER: I expect so, yes.
14 MR GARNHAM: Was it discussed there that consultants,
15 including you, value social worker presence at Monday
16 meetings?
17 DR ROSSITER: Yes.
18 MR GARNHAM: And was the response from social workers that,
19 as set out in that document, that they are ignored at
20 meetings? Was that their response at that meeting?
21 DR ROSSITER: This was said to us and we -- Dr Naidoo, my
22 psychiatry colleague, and I tried to explain we felt the
23 reaction of one particular social worker who attended
24 might be related to health issues and that we felt that
25 she was a lady who needed help. And the response to
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1 that was that she was a member of their department and
2 the impression we had was that they preferred her
3 opinion to ours. We spent a lot of time smiling at her
4 and she did not smile back at us. This was the
5 perception on the ward, that we were doing rather a lot
6 of one-handed clapping. This is why I really did not
7 want to speak to this.
8 MR GARNHAM: You may not want to, Doctor, but I am afraid
9 I have to ask you about it. Can you tell us who this
10 individual is, please?
11 DR ROSSITER: I have gone blank. I am sorry, I have
12 terrible trouble with names. If I am given the names
13 I can tell you who it is but it is the social worker who
14 is on long-term sick leave at present.
15 MR GARNHAM: That may not narrow it down sufficiently for me
16 to be able to identify it properly.
17 DR ROSSITER: I think you will find the social work people
18 who are here will know who it is. I believe Karen Johns
19 is here and I think she can identify her.
20 MR GARNHAM: That is not going to help me so I will have to
21 ask you, I am afraid, to think about it.
22 DR ROSSITER: It may come to me. I have terrible trouble
23 with names.
24 MR GARNHAM: If it comes to you, perhaps you would let us
25 know who it is.
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1 DR ROSSITER: Yes.
2 MR GARNHAM: But there is a particular individual, you say,
3 about whom you had concerns?
4 DR ROSSITER: Yes.
5 MR GARNHAM: But when expressed you were met with the
6 response from the social services team that they
7 preferred her views to yours?
8 DR ROSSITER: That we were unfriendly and that she was not
9 listened to.
10 THE CHAIRMAN: Mr Garnham, I really am very sorry to
11 interrupt. I hope you agree it is the first time I have
12 done this.
13 Doctor, to be absolutely blunt with you, I am not
14 interested in the pledge that you have made to yourself,
15 I am interested in you being as helpful as you can to
16 this Inquiry. Therefore, I expect you to answer the
17 questions Mr Garnham puts to you as thoroughly as you
18 can.
19 DR ROSSITER: I am grateful to you, sir. I really cannot
20 remember the name of this person but I am sure the
21 health staff sitting behind me know exactly who it is
22 and may be able to slip a note to Mr Mason.
23 THE CHAIRMAN: I hope you accept the point I am making which
24 is: I hope you will answer Mr Garnham's questions as
25 thoroughly as you can and not be affected by any pledge
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1 that you have made to yourself.
2 DR ROSSITER: Thank you, sir.
3 MR GARNHAM: I am still not sure where we are going with
4 this even if you do identify the individual. What is
5 the point?
6 DR ROSSITER: We believed that this is a lady who had got
7 a depression and was not able to appreciate our
8 multi-disciplinary working.
9 MR GARNHAM: Yes, but so what?
10 DR ROSSITER: So that when she reported back that social
11 workers feel they are ignored at the meeting, we did not
12 believe we were ignored.
13 MR GARNHAM: I see. I understand.
14 DR ROSSITER: We would speak to her in a friendly manner and
15 she would glare back at us.
16 MR GARNHAM: The next point is:
17 "Social workers' opinion on a case are often not
18 heard or respected by other professionals present."
19 Is that the same point?
20 DR ROSSITER: Yes.
21 MR GARNHAM: "When social work feedback is requested on a
22 case space is not always provided for this to be stated
23 in meetings."
24 DR ROSSITER: Well it is a rather unstructured meeting and
25 a lot of us do chip in and I am the main perpetrator.
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1 I am afraid I do talk too much.
2 MR GARNHAM: "The meeting is not clearly structured so that
3 reasonable debate between professionals can occur and
4 clear referral is made and accepted or declined with
5 reasons."
6 DR ROSSITER: Again, that is a perception that we had to
7 leave it; that we had two different ways of interpreting
8 it.
9 MR GARNHAM: But the net result of all this, as I understand
10 your evidence, is that social workers were making clear
11 they did not intend to come to the psychosocial meetings
12 on a Monday afternoon; is that right?
13 DR ROSSITER: Yes.
14 MR GARNHAM: Is that what in fact occurred thereafter from
15 December 1997 or earlier through to the time of
16 Victoria's case?
17 DR ROSSITER: Yes.
18 MR GARNHAM: So for at least 18 months we have a situation
19 where what was described by Nurse Norman as a vital
20 vehicle for transferring information between the two
21 agencies was inhibited by the fact that there was no
22 social work presence there?
23 DR ROSSITER: Yes.
24 MR GARNHAM: Nurse Norman said that sometimes Enfield social
25 workers attended -- sir the reference is Day 19,
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1 page 175, line 22 -- sometimes Enfield attended but
2 Haringey never did. Is that your recollection?
3 DR ROSSITER: Well there were no Haringey social workers in
4 the hospital to attend. Very occasionally, if one rang
5 with a particular interest, we would invite them to join
6 us. In my evidence I talk about the attendees and when
7 I put "sometimes other people by invitation" -- if
8 somebody rang and said they wanted to discuss, we would
9 say, "We have our 2 o'clock meeting, why do you not come
10 and join us?"
11 MR GARNHAM: And would they?
12 DR ROSSITER: Yes.
13 MR GARNHAM: That is from Haringey?
14 DR ROSSITER: Yes.
15 MR GARNHAM: Routinely, did anybody from Enfield, such as
16 Karen Johns, attend?
17 DR ROSSITER: Karen used to come to the neonatal ones when
18 the system was working.
19 MR GARNHAM: I am interested in the CPT ones.
20 DR ROSSITER: I do not remember it.
21 MR GARNHAM: Is that all the product of this disagreement
22 about the structure of these meetings?
23 DR ROSSITER: I think it was also financial.
24 MR GARNHAM: Aside from the two meetings, the minutes of
25 which we have looked at, were there any other efforts
161
1 made to encourage social workers to attend?
2 DR ROSSITER: There were the three monthly meetings which we
3 had with Dr Naidoo, myself and representatives from
4 Enfield Social Services and Haringey Social Services,
5 together with the manager for the hospital social
6 workers, and at that time the Enfield representative was
7 Sue Patterson and the Haringey representative was
8 Petra Kitchman. This, again, I am afraid was
9 a reasonably informal meeting. Where I said it was
10 minuted I think notes were taken but because Dr Naidoo
11 and I were so distressed about this it would come up as
12 an item for discussion fairly regularly because we were
13 worried.
14 MR GARNHAM: Was there any consideration given to arranging
15 these meetings at a time that was more convenient to
16 social services?
17 DR ROSSITER: We held the meetings at lunchtime because that
18 is one of the few times in a hospital timetable that you
19 can actually get people around a table.
20 MR GARNHAM: Was it ever put to you that that was not
21 a convenient time for social workers to attend?
22 DR ROSSITER: I do not recall it being so.
23 MR GARNHAM: Apart from the objections that we have heard
24 discussed, which arise out of those two meetings in
25 1997, were there any other substantive objections put
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1 forward by social services as to why they could not
2 attend the meetings as currently arranged?
3 DR ROSSITER: Not that I recall.
4 MR GARNHAM: It is a fair point, is it not, for social
5 services to make that these meetings were pretty
6 unstructured?
7 DR ROSSITER: Yes.
8 MR GARNHAM: And that the minutes were rough and ready, to
9 put it kindly?
10 DR ROSSITER: The point is not only taken but we have taken
11 means to make that better. I absolutely agree.
12 MR GARNHAM: Was that not a concern of social services that
13 they were being expected to turn up to meetings that
14 were carried out in this rather amateurish way?
15 DR ROSSITER: I think it is because different disciplines
16 have different ways of meeting and certainly, from my
17 dealings with social services, they have a very
18 structured way of looking at things. Whereas in health,
19 because everything changes every day, we do have a more
20 informal way of doing things. I go by a principle of
21 tight/loose -- I hope this is relevant here -- where you
22 have something that is agreed by everybody that has to
23 be adhered to but that allows people to use their
24 imagination when it becomes -- it allows lateral
25 thinking. So we very often have meetings of colleagues
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1 who get together. We have a feeding forum, for
2 instance; we have a constipation forum where
3 professionals just get together and exchange views, as
4 it were.
5 MR GARNHAM: Not so much amateurish as informal?
6 DR ROSSITER: Informal, thank you.
7 MR GARNHAM: It is right -- and we will come to look at them
8 in Victoria's case in a moment -- it is right these
9 minutes were often not properly minuted, there was
10 simply a rough note taken of what went on?
11 DR ROSSITER: Indeed, and in fact it is the senior house
12 officer in psychiatry who did it and it sounds a bit
13 silly but almost we were pleased that she did it as
14 a favour. We have now corrected that and there are
15 forms for these to be minuted. In fact there are two
16 means. If it is more of a clinical or a child in need
17 then this will be minuted on a form that says
18 "psychosocial meetings". However, if it is a child
19 protection case we will use the CP6 to document the
20 decisions.
21 MR GARNHAM: Though not in Victoria's case.
22 DR ROSSITER: No. No, it was not happening at all then,
23 I regret.
24 MR GARNHAM: In Victoria's case it was just a matter of
25 a note on a piece of paper?
164
1 DR ROSSITER: It was in a book.
2 MR GARNHAM: In a book?
3 DR ROSSITER: Which was kept in the psychiatry department.
4 Indeed.
5 MR GARNHAM: So another place for the keeping of notes on
6 a case. Somebody who is trying to read up on everything
7 about a patient has to go to quite a few places to get
8 material.
9 DR ROSSITER: One would hope the material would come
10 together in one place at a strategy meeting or a case
11 conference, because in a case where we are wanting --
12 thinking about emotional abuse then I would have
13 expected a psychiatrist or psychotherapist to have come
14 to that meeting.
15 MR GARNHAM: But if somebody wants to keep their finger on
16 the pulse in a case that is going on in the ward you
17 have to go to the psychiatry department to obtain this
18 information, you have to get the legal notes, the notes
19 at the foot of the bed.
20 DR ROSSITER: Point is taken.
21 MR GARNHAM: It does sound a little chaotic.
22 DR ROSSITER: Yes.
23 MR GARNHAM: You tell us the same problem about
24 non-attendance of social workers affected the
25 non-accidental injury form as well.
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1 DR ROSSITER: Yes.
2 MR GARNHAM: What was done about that?
3 DR ROSSITER: Well there were three meetings that we were
4 actually expecting the social workers at. So it came as
5 a package as it were.
6 MR GARNHAM: So the same points apply to each of those
7 categories of meeting?
8 DR ROSSITER: The same apply. There was the 2 o'clock on
9 Monday, the NAI meeting on Tuesday and then the neonatal
10 ones on Wednesday.
11 MR GARNHAM: And social workers were not attending any of
12 these, is that right?
13 DR ROSSITER: I do not believe so. I cannot speak for the
14 neonatal ones because I did not attend regularly myself.
15 MR GARNHAM: I am principally interested in the other two
16 anyway.
17 DR ROSSITER: Indeed, yes.
18 MR GARNHAM: You tell us social workers were not attending
19 these.
20 DR ROSSITER: That is my recollection.
21 MR GARNHAM: You understand that the reason was the same
22 identified in the minutes to which I have taken you.
23 DR ROSSITER: Yes.
24 MR GARNHAM: There was no NAI form in respect of Victoria,
25 was there?
166
1 DR ROSSITER: I am sure there was.
2 MR GARNHAM: You are sure there was?
3 DR ROSSITER: Well we certainly met. I am sure we did
4 because the letter that -- the second letter I wrote to
5 Petra Kitchman asking where she was at school who her GP
6 was, that would not have come from my mind, that would
7 have been triggered by a health visitor. So at least
8 a health visitor and I would have met, even if it was
9 only the two of us.
10 MR GARNHAM: This is some time after Victoria's discharge
11 though.
12 DR ROSSITER: Yes.
13 MR GARNHAM: There was no NAI meeting about Victoria during
14 her time on the ward.
15 DR ROSSITER: You mean the Tuesday one?
16 MR GARNHAM: Yes.
17 DR ROSSITER: When we have children who are on the ward for
18 child protection concerns, their name would come up in
19 conversation at the Tuesday meeting, then one would say,
20 "Yes, she is on the ward, we discussed her yesterday at
21 the Monday meeting". So she would be thought about but
22 not discussed because it had been done the previous day.
23 MR GARNHAM: Your recollection then is although Victoria's
24 case was not particularly discussed at an NAI forum,
25 that there was a meeting between you and a liaison
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1 health visitor in respect of Victoria some time after
2 her discharge.
3 DR ROSSITER: Yes.
4 MR GARNHAM: And that it was that that prompted your letter
5 to Kitchman?
6 DR ROSSITER: The first letter I believe I dictated on the
7 Monday, the day that I knew she had gone home. I think
8 you can see from the way I have written it that I was
9 not entirely calm when I dictated it.
10 MR GARNHAM: I am going to come on to that. At the moment
11 could you just confine your answer to deal with --
12 DR ROSSITER: Sorry. The first thing I did was I dictated
13 the letter and the summary on the Monday, then on the
14 Tuesday I expect, though I cannot be certain, it would
15 have come up in discussion with a liaison health
16 visitor, "This is what I have done".
17 MR GARNHAM: That meeting and what you decided as a result
18 of it goes unminuted, unnoted.
19 DR ROSSITER: Regretfully, yes.
20 MR GARNHAM: So there is actually no record that we can look
21 at as to what was decided between you and that health
22 visitor.
23 DR ROSSITER: We have since discovered that, yes.
24 MR GARNHAM: Yet again that is not entirely satisfactory, is
25 it?
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1 DR ROSSITER: It is extremely unsatisfactory.
2 MR GARNHAM: You then go on in your statement to discuss the
3 departmental seniors' meetings, the ward management
4 meeting and the hospital community liaison working
5 group.
6 DR ROSSITER: That is the three-monthly one I mentioned
7 previously.
8 MR GARNHAM: I see. Victoria's case not discussed at any of
9 those?
10 DR ROSSITER: I cannot remember.
11 MR GARNHAM: No note of it in a minute of any of those
12 meetings?
13 DR ROSSITER: I really do not know, I am sorry.
14 MR GARNHAM: If you had concerns, as you say in your
15 statement -- and we will come back to this -- about
16 follow-up for Victoria, would the liaison working group
17 not have been the obvious place in which to raise those
18 concerns?
19 DR ROSSITER: Or indeed any other occasion when I had seen
20 Petra Kitchman when she was chairing a case conference
21 or something.
22 MR GARNHAM: Yes, thank you. Let us go back, then, to where
23 we were before we dealt with these new documents and to
24 the facts of Victoria's case. Can you turn, please, to
25 page 55 in volume 37, if you still have that. We have
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1 looked at this page before, the last paragraph dealing
2 with conclusions, and there is an annotation on that.
3 DR ROSSITER: With my squiggle.
4 MR GARNHAM: That annotation reads "1st August 1999. What
5 is uncertain is the category" and there is an arrow
6 drawn from the end of tick box 3 to the end of tick box
7 4.
8 DR ROSSITER: "2. I consider the incident is likely to be
9 non-accidental", yes.
10 MR GARNHAM: First of all, what is the intention behind the
11 arrow?
12 DR ROSSITER: It was to show there was a change in the
13 conclusion.
14 MR GARNHAM: And explain the annotation.
15 DR ROSSITER: Because I was seeing this as a child who got
16 abuse in various categories, which we have talked about
17 before. I was thinking this is apart from the physical
18 abuse, which at that time I believed to have been
19 documented erroneously I now discover, but I believed it
20 had been documented and I was now putting more emphasis
21 on the emotional abuse and the neglect.
22 MR GARNHAM: But all we get from the annotation is what is
23 uncertain is the category and that presumably refers to
24 the categories of non-accidental injury.
25 DR ROSSITER: Yes.
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1 MR GARNHAM: That is all I wanted to establish thus far.
2 DR ROSSITER: Yes.
3 MR GARNHAM: Was more than one copy of CP3 kept on the file
4 in the hospital?
5 DR ROSSITER: No.
6 MR GARNHAM: So when you were annotating this, what date did
7 you make the annotation?
8 DR ROSSITER: 1st August, on the Sunday ward round.
9 MR GARNHAM: You were making it on the only copy of CP3 that
10 there existed, as far as you knew?
11 DR ROSSITER: Yes.
12 MR GARNHAM: Is it possible that there had already been sent
13 to the social worker CP3 in its unannotated form?
14 DR ROSSITER: Oh yes, it was, because that was what was
15 taken to the strategy meeting.
16 MR GARNHAM: Yes. What then happened to this amendment?
17 DR ROSSITER: It lived in the notes, pending the expectation
18 of a further meeting when I could report it further.
19 MR GARNHAM: Was this annotated form ever sent to the social
20 workers?
21 DR ROSSITER: No.
22 MR GARNHAM: So the correction you have made remains known
23 only to the hospital?
24 DR ROSSITER: Yes.
25 MR GARNHAM: And social workers are unaware that you now
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1 changed the category of conclusion?
2 DR ROSSITER: Yes.
3 MR GARNHAM: And are unaware of your observation, what is
4 uncertain is the category?
5 DR ROSSITER: From this, yes.
6 MR GARNHAM: We have another investigation of this form.
7 I would like you to look at it, please. Volume 6,
8 page 286. Do you have that?
9 DR ROSSITER: Yes. It looks the same, it is just
10 a different photocopy.
11 MR GARNHAM: Look at the top, the very top of the page. It
12 looks as if it has been faxed --
13 DR ROSSITER: Ahh.
14 MR GARNHAM: -- on 3rd August at 12.20.
15 DR ROSSITER: Then I stand corrected, it was sent.
16 MR GARNHAM: From John Gilpin Ward.
17 DR ROSSITER: Yes.
18 MR GARNHAM: Lisa Arthurworrey tells us that she received by
19 fax a copy of CP3.
20 DR ROSSITER: Then I was not aware of it and I am grateful
21 to you.
22 MR GARNHAM: But it means, does it not, she then has two
23 versions of CP3?
24 DR ROSSITER: Yes.
25 MR GARNHAM: Both the one with the annotation and the one
172
1 without?
2 DR ROSSITER: Yes. I was unaware this was sent to her.
3 MR GARNHAM: Two points arise from that, Doctor. First of
4 all, ought you not to have made arrangements for her to
5 see the amendment, if you considered it significant?
6 DR ROSSITER: It depends on who is being proactive. I take
7 your point: I should have been proactive, but the stage
8 we were at was information had been offered; we had had
9 a psychosocial meeting where we had shared our
10 information so far and it had been decided that a person
11 in the team, who turned out to be Isobel Quinn, should
12 fax relevant information to the social worker. I do not
13 recall whether we decided exactly which pieces of paper
14 should be sent, but I am very grateful to Isobel for so
15 doing.
16 MR GARNHAM: I am still a little concerned about the nature
17 of the amendments that you made.
18 DR ROSSITER: Yes.
19 MR GARNHAM: Because if there were in existence more than
20 one version of this form, perhaps because an original
21 was collected and a later one was faxed, it is not
22 immediately obvious that the amendments are made and it
23 might be missed by someone looking at it. If hidden
24 away in the six or seven pages of the CP form there is
25 one page where a consultant has written these words on
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1 it, there is a danger they will not be picked up by
2 subsequent readers.
3 DR ROSSITER: That had not occurred to me. Thank you for
4 it.
5 MR GARNHAM: But it is a risk, is it not?
6 DR ROSSITER: Yes.
7 MR GARNHAM: Because you do not flag up the fact that
8 amendment has been made. You do not write a letter
9 saying, "I have now amended the CP form, see page 3".
10 DR ROSSITER: I do sometimes.
11 MR GARNHAM: But you did not here?
12 DR ROSSITER: I am thinking of clinical circumstances, I may
13 well have written on a letter and sent a further copy
14 saying "see my amendments" or "further copy enclosed".
15 MR GARNHAM: But that point applies not only to social
16 workers but also to other members of medical staff does
17 it not?
18 DR ROSSITER: Oh yes.
19 MR GARNHAM: They might not have appreciated that you made
20 this alteration to the CP forms?
21 DR ROSSITER: Yes.
22 MR GARNHAM: That is unsatisfactory, is it not?
23 DR ROSSITER: I am having a little difficulty following your
24 argument.
25 MR GARNHAM: Well, the point is this: that the CP form in
174
1 its original state comes into existence when it is
2 completed by Dr Forlee.
3 DR ROSSITER: Yes.
4 MR GARNHAM: Some time later you make an annotation and an
5 amendment to it.
6 DR ROSSITER: Yes.
7 MR GARNHAM: If there is more than one copy to it and
8 anybody looks at it the amendment may not be obvious.
9 DR ROSSITER: I take your point.
10 MR GARNHAM: Let us go back, if we may, to the original CP
11 forms and to CP5 which is at page 57. I want to
12 understand what you have put on there.
13 DR ROSSITER: Yes.
14 MR GARNHAM: The second box is dealing with people who need
15 to be informed.
16 DR ROSSITER: Yes.
17 MR GARNHAM: "Have the following been informed: Consultant
18 Paediatrician [you]: yes. Senior Registrar Banjoko:
19 yes. Social worker Lucienne Fredrick".
20 DR ROSSITER: Yes.
21 MR GARNHAM: A note is crossed out and "yes" is put in its
22 place. Who was that by?
23 DR ROSSITER: The "yes" is me and I think the reason I have
24 crossed it out is you are not supposed to put other
25 information there. I am not quite sure what it is
175
1 underneath it but you are supposed to put "action
2 needed", "yes" or "no" in that column.
3 MR GARNHAM: I think it is "message left".
4 DR ROSSITER: Ahh, because as you can see that column is
5 dedicated to "yes" or "no", so I had sort of done that
6 because it was put in the wrong place and put what
7 I wanted to put there, which was "yes".
8 MR GARNHAM: Did you know whether Lucienne Fredrick was the
9 social worker who had been allocated this case?
10 DR ROSSITER: No.
11 MR GARNHAM: So it is simply a matter of she was a social
12 worker that was informed?
13 DR ROSSITER: She was the duty social worker and as a duty
14 social worker at a weekend she would have more hands on
15 responsibility than sort of someone you rang on a Monday
16 or Tuesday.
17 MR GARNHAM: Thank you. Then the next line: "Health
18 visitor: via an LHV". Liaison health visitor?
19 DR ROSSITER: Yes.
20 MR GARNHAM: So does that mean that the health visitor had
21 been informed?
22 DR ROSSITER: This was an expectation that it would happen.
23 This I did on the Sunday the day after the child came in
24 and this was for planning. I wrote down that I expected
25 the health visitor to be told by the liaison health
176
1 visitor who of course would not come on duty until the
2 Monday.
3 MR GARNHAM: It is slightly misleading, is it not, because
4 this box is in the past tense, "Have the following been
5 informed?"
6 DR ROSSITER: Oh.
7 MR GARNHAM: So it seems to be asking what has happened.
8 DR ROSSITER: It does say "action needed" then "action
9 achieved" and I can see that I am going to have to go
10 back to the drawing board and re-word that.
11 MR GARNHAM: I see, so --
12 DR ROSSITER: It has noted confusion before.
13 MR GARNHAM: It is probably just me being overlegalistic
14 about it. The intention is that the first column is an
15 indication that the process has started, and the second
16 column an indication the process has been completed.
17 DR ROSSITER: You ask yourself have the following been
18 informed? Do I need to do it: yes or no? Have I done
19 it? Yes, I have to date it. Further opinion needed: do
20 I need an ophthalmologist? Do I need an orthopaedic
21 surgeon? Then you go down that list answering a
22 question to yourself: "Yes I need to do it. No I do not
23 need to do it". Then at a later date you cross-check
24 that it has been done. It is an aide-memoire.
25 MR GARNHAM: So the same applies to family doctor because
177
1 you have written "at summary".
2 DR ROSSITER: Yes.
3 MR GARNHAM: That is your words?
4 DR ROSSITER: Yes.
5 MR GARNHAM: The indication by that annotation is that you
6 intended that the family doctor should be informed by
7 service of a copy of the discharge summary?
8 DR ROSSITER: Yes.
9 MR GARNHAM: How were you going to do that? Did you know
10 who the family doctor was?
11 DR ROSSITER: I did not. Clearly I had intended that we
12 should know and then there is a curious thing put in by
13 Dr Reynders in the wrong place where he knew who the GP
14 was but it was not put where it should be, either at the
15 front of CP1 or in any of the places that the
16 secretaries would normally look.
17 MR GARNHAM: And the result was the discharge summary was
18 never sent to Victoria's GP, is that right?
19 DR ROSSITER: Yes.
20 MR GARNHAM: So that although you had intended that should
21 happen, that intention was never put into effect?
22 DR ROSSITER: No.
23 MR GARNHAM: Let us move on to the 25th July, please. You
24 went to the hospital that morning to conduct a routine
25 ward round?
178
1 DR ROSSITER: Yes.
2 MR GARNHAM: Did you see Victoria?
3 DR ROSSITER: Yes. The exact circumstances are, to put it
4 mildly, hazy as you may well have gathered. I believe
5 that I actually started with her. I believe that what
6 happened was that -- this is what I have worked out in
7 retrospect. I believe that because I had been
8 telephoned by Simone Forlee who was clearly anxious and
9 because I knew she was going off duty, I went over the
10 forms with her. Now, what I do not know is whether
11 I examined the girl at the time. I mean she could have
12 been asleep, it could have been anything. But had
13 I seen her as we progressed round the ward round with
14 the trolley, then it would have been written, "Ward
15 round, Dr Rossiter saw Anna". So I believe that what
16 may have happened is that we sort of said, "Well, seen
17 her already". I have written on the CP forms and it is
18 a reason, not an excuse, but I think that is a reason
19 why there is no documentation of my seeing her in the
20 medical notes.
21 MR GARNHAM: We have discussed this before: but you did not
22 examine her that morning, there was not a full body
23 examination?
24 DR ROSSITER: Not a full examination. I think that her
25 appearance was pointed out to me and, out of that,
179
1 looked at the totality of all these injuries and looking
2 at them my attention was struck by the looped marks.
3 MR GARNHAM: This was on the morning of the 25th?
4 DR ROSSITER: Yes.
5 MR GARNHAM: Yes.
6 DR ROSSITER: And obviously that excited my curiosity --
7 MR GARNHAM: Before you go on to tell us that, is that after
8 the nurses bathed Victoria and pointed this out to you?
9 DR ROSSITER: I believe so.
10 MR GARNHAM: You say in your statement that you glimpsed her
11 briefly after that.
12 DR ROSSITER: I think I looked at her, noted that she had
13 injuries which needed to be documented and drawn
14 properly, had a thought about what could these marks be,
15 wondered whether they would be looped wire as a guess,
16 and wished for it to be properly documented by a senior
17 house officer.
18 MR GARNHAM: This must have given you the most serious
19 concerns.
20 DR ROSSITER: Yes.
21 MR GARNHAM: Signs that she had been struck with possibly
22 looped wire?
23 DR ROSSITER: Yes.
24 MR GARNHAM: So whatever your original fears of Victoria,
25 this now moved up a category. You had seen clear
180
1 physical signs of the most of appalling type of abuse?
2 DR ROSSITER: Yes, appalling. The problem is when you have
3 seen things before you get slightly numbed.
4 MR GARNHAM: Yes, I can see that. Well of serious abuse
5 anyway, if not the most serious.
6 DR ROSSITER: Yes.
7 MR GARNHAM: Still there is no full examination done of
8 Victoria that day.
9 DR ROSSITER: My belief is that I thought I had delegated it
10 to a senior house officer who had sufficient experience
11 and ability to do it for me.
12 MR GARNHAM: This is Reynders?
13 DR ROSSITER: Yes.
14 MR GARNHAM: Are you saying that you now think that that is
15 what you did?
16 DR ROSSITER: I know that that was my expectation. What
17 I cannot remember is how I arranged for it to be done,
18 whether I spoke to him in person or left a message with
19 a nurse. It was clearly inadequate. I should have done
20 more.
21 MR GARNHAM: The impression we get from your statement is
22 you quite rated Dr Reynders as a good doctor.
23 DR ROSSITER: Oh yes.
24 MR GARNHAM: If you had given him instruction in a case like
25 this, following findings like those, that there should
181
1 be a full examination of Victoria's body, he would have
2 done that, would he not?
3 DR ROSSITER: He would have done it but if he was
4 overwhelmed by other work -- and bear in mind that on
5 a Sunday he is the only doctor covering casualty and the
6 ward -- he may have not given it the full priority and
7 have done it straight away, but I believed the next day
8 that he had already done it, which is why I did not
9 check.
10 MR GARNHAM: How long did that belief last?
11 DR ROSSITER: Oh, till I looked at the papers again in more
12 detail.
13 MR GARNHAM: You mean after Victoria's death?
14 DR ROSSITER: Oh, yes.
15 MR GARNHAM: Here we have a case of a child being admitted
16 with suspected child abuse, no full examination done by
17 the SHO for reasons that may or may not be
18 understandable, you then do a ward round the following
19 day. During or after that your attention is drawn by
20 nurses who have bathed her --
21 DR ROSSITER: Yes.
22 MR GARNHAM: -- to marks including a looped wire mark on the
23 child's body?
24 DR ROSSITER: Yes.
25 MR GARNHAM: You do not do a full examination, you expect an
182
1 SHO to do one and you do not check that that happens?
2 DR ROSSITER: No.
3 MR GARNHAM: So we drift into the next day, the 26th, and
4 there still has not been a full examination, so far as
5 we know.
6 DR ROSSITER: It is dated the Monday, which is the 26th,
7 I believe. I believe it was completed in time for the
8 psychosocial ward round, and I believe -- I know it was
9 completed in time for Karen Johns to take it with her to
10 the strategy meeting.
11 MR GARNHAM: The product of that examination was the body
12 maps.
13 DR ROSSITER: Yes.
14 MR GARNHAM: We have no description of that examination,
15 just the completion of the body maps.
16 DR ROSSITER: Yes. Would you like me to clarify?
17 MR GARNHAM: Yes, please.
18 DR ROSSITER: We instruct our doctors -- I think I have said
19 this already -- that they make factual diagrams, they do
20 not put a conclusion on it in case it misleads the
21 court. The forms that they are done on are -- the body
22 maps we only use for child protection purposes. Other
23 body maps are used for other purposes. So if it was
24 burns or examination of abdomen we have different body
25 maps. Those forms are found in our NAI box, it is
183
1 a box, a kit that we have for -- and they are only used
2 for child protection purposes. Now, I would not --
3 I should not expect someone to assume just because it is
4 written on that that it is a child protection
5 documentation, but in my mind it is child protection
6 documentation.
7 MR GARNHAM: But even if it is, the fact that there is
8 a mark recorded on the body map does not mean that that
9 mark was caused by abuse, does it?
10 DR ROSSITER: There should have been a comment made.
11 MR GARNHAM: Not only should there have been a comment made,
12 Doctor, but surely there should have been a description
13 of what was discovered on that examination?
14 DR ROSSITER: Yes.
15 MR GARNHAM: And there was not?
16 DR ROSSITER: No.
17 MR GARNHAM: Never mind for the moment the examination,
18 which you have told us about and which did not happen
19 until the 26th; your observations of looped wire marks
20 on the child's body were not recorded anywhere, were
21 they?
22 DR ROSSITER: No.
23 MR GARNHAM: So that even if it is right that you had
24 delegated the examination to another doctor, surely you
25 should have had someone make a record of those
184
1 observations?
2 DR ROSSITER: Yes.
3 MR GARNHAM: And you failed to do so?
4 DR ROSSITER: I did.
5 MR GARNHAM: If there were, as you say there were, marks on
6 Victoria's body indicative of other forms of
7 non-accidental injury, was that not relevant to deciding
8 whether or not the burns were also non-accidental?
9 DR ROSSITER: It was -- well, it was and to some extent
10 I took it into consideration, but my mind was going more
11 in terms of neglect.
12 MR GARNHAM: But looped wire is not -- looped wire marking
13 is not neglect.
14 DR ROSSITER: It is vicious, yes.
15 MR GARNHAM: So how is your mind moving in terms of neglect
16 when you see marks of looped wire?
17 DR ROSSITER: I do not think it moved far enough to consider
18 that the burns could have been inflicted by an adult.
19 That was an omission.
20 MR GARNHAM: Thank you for the candour about that. Let us
21 make sure we understand it. Do you accept that having
22 found other evidence of physical abuse, that you should
23 have asked yourself whether the burns might not be part
24 of a pattern of abuse?
25 DR ROSSITER: In retrospect it is very obvious.
185
1 MR GARNHAM: You say that when you looked at Victoria,
2 glimpsed her or looked at her, that her skin was
3 markedly inflamed.
4 DR ROSSITER: Yes.
5 MR GARNHAM: You were still able nonetheless to make out
6 that side of chastisement as you thought it to be.
7 DR ROSSITER: Yes.
8 MR GARNHAM: I understand your evidence to be because it was
9 inflamed you were not able to make out some of the other
10 marks which subsequently became apparent?
11 DR ROSSITER: This comes out of my shock when I first saw
12 the photographs, and then I went back to the diary in
13 order to give evidence at the criminal trial and that
14 was when I worked out there had been a four-day gap. It
15 was from that that I concluded that these marks had
16 become scabbed. Not only that, that the information of
17 the dermatitis had receded and that is very obvious in
18 the photographs.
19 MR GARNHAM: Let me see if I have understood this correctly.
20 When you glimpsed or looked at Victoria you noticed that
21 despite the fact that her skin was inflamed by
22 dermatitis, the chastisement mark --
23 DR ROSSITER: Yes.
24 MR GARNHAM: -- the other marks which were revealed to you
25 later by the photographs were not obvious at that
186
1 glimpse?
2 DR ROSSITER: They were the same marks. They were looped
3 marks but I could only see a line to them. Either
4 because they developed or because other people had
5 different theories, it was thought by others that it
6 could have been a belt, which is a very reasonable
7 conclusion.
8 MR GARNHAM: The photographs were eventually taken on
9 29th July.
10 DR ROSSITER: Yes.
11 MR GARNHAM: We know by that time some of the inflammation
12 had died down and that is why these marks are more
13 obvious.
14 DR ROSSITER: Yes.
15 MR GARNHAM: So you tell us for that reason those
16 photographs do not represent the picture as you saw it
17 at that first glimpse.
18 DR ROSSITER: No.
19 MR GARNHAM: Were you able to examine Victoria again after
20 the 26th?
21 DR ROSSITER: I could have done but I did not.
22 MR GARNHAM: So you did not examine Victoria again on any
23 occasion thereafter?
24 DR ROSSITER: No. I was covering the baby unit the first
25 week and when I did the ward round on 1st August, when
187
1 I started pulling my thoughts together about what was
2 going on, I erroneously believed that this had all been
3 documented by the team and the physical abuse had been
4 documented, it was accepted, even though I was obviously
5 very woolly about it and I was turning my attention to
6 the emotional abuse and the neglect, which were
7 increasingly concerning me.
8 MR GARNHAM: If you had glanced through the notes, and it
9 may be that you did do that, you would have seen, would
10 you not, that the only record of any examination was the
11 body maps?
12 DR ROSSITER: I should have noticed that.
13 MR GARNHAM: If you had examined Victoria at any time after
14 the 29th/30th July when she was there to be examined,
15 had you chosen to do so, you would have seen what is now
16 revealed by the photographs?
17 DR ROSSITER: Yes.
18 MR GARNHAM: The inflammation is an explanation for why you
19 were not aware of the seriousness of the marks, only for
20 the first couple of marks.
21 DR ROSSITER: Oh, I was aware of the seriousness of them.
22 I was not aware of the cause of them.
23 MR GARNHAM: And their extent?
24 DR ROSSITER: I am not sure.
25 MR GARNHAM: Back to the 25th. You say that having seen
188
1 that her skin was markedly inflamed you requested
2 a swab.
3 DR ROSSITER: Yes.
4 MR GARNHAM: That is to check for infection presumably?
5 DR ROSSITER: Yes.
6 MR GARNHAM: And the proper clerking of the case?
7 DR ROSSITER: Yes.
8 MR GARNHAM: Neither of these are as important as recording
9 your observation about beatings with wire, are they?
10 DR ROSSITER: No, they are not.
11 MR GARNHAM: So it seems strange that they should have won
12 your attention whereas the noting did not, but that is
13 an error by you?
14 DR ROSSITER: Yes. I cannot explain it this far later.
15 MR GARNHAM: Is the proper admission the document -- and
16 I know that is a sort of term of art -- is that the
17 document we now have in volume 37 at page 252?
18 DR ROSSITER: Yes, indeed.
19 MR GARNHAM: I think you probably guessed my next question.
20 If this is an attempt at a proper clerking of this
21 patient it does not look to be terribly impressive.
22 DR ROSSITER: No.
23 MR GARNHAM: We perhaps do not have it in the right order,
24 which may be a partial explanation. Because it looks as
25 if the first page at 252 is a continuation sheet and it
189
1 may that be 254 is the first page.
2 DR ROSSITER: No. It starts off with -- I am going to have
3 trouble as well. The first page is the original
4 history. Here we go: 256. Then the second page is
5 about previous illnesses and immunisation.
6 MR GARNHAM: I think this is simply in reverse order then.
7 That is of some help.
8 DR ROSSITER: Right. Is it? No, it is not.
9 MR GARNHAM: You take us through it. We start with
10 page 256, which has history of presenting complaint.
11 DR ROSSITER: Yes. Then --
12 MR GARNHAM: Before we leave that let us make sure we
13 understand what is there, 256:
14 "Anna has been [something] due to scabies".
15 DR ROSSITER: "... itching plus plus plus due to scabies.
16 Went to the bathroom by herself alone and poured hot
17 water over her head. Mum only heard the screaming and
18 subsequently brought her to the hospital."
19 MR GARNHAM: It is interesting, just as in passing, that the
20 note is as emphatic as you can get it: went to the
21 bathroom not only by herself but also alone.
22 DR ROSSITER: Yes.
23 MR GARNHAM: It sounds as if somebody is keen to make the
24 point that this was done alone.
25 DR ROSSITER: Yes. This is written on the 25th at
190
1 1 o'clock. One of the things you will discover is not
2 there is a signature by the doctor who wrote this.
3 MR GARNHAM: Yes.
4 DR ROSSITER: The status of this first page I need to
5 explain to you. The doctors are told that if they are
6 filling in CP forms they use those as the main history
7 because we do not want them to clerk on to clinical
8 notes and then copy into the CP forms. We want the CP
9 forms to be used first because they are contemporaneous.
10 MR GARNHAM: Yes.
11 DR ROSSITER: Then they are allowed to write under the
12 history something quite brief and then say "see CP
13 forms." So as far as the history is concerned, a very
14 brief history would be excusable.
15 MR GARNHAM: Although this does not actually say "see CP
16 form", does it?
17 DR ROSSITER: No, but it could have done. But the not
18 filling in the examination is, to my mind, astonishing.
19 The time I would have most usefully noticed that would
20 have been on the Monday morning when I did the ward
21 round, except I did not do the ward round because I had
22 gone to my duties on the baby unit. So before you ask
23 me, it has fallen between two people again.
24 MR GARNHAM: Your word is "astonishing" and I might well
25 have chosen that word as well; but it is even more
191
1 extraordinary given that you had expressly instructed
2 that proper clerking should be done because previously
3 there had not been any.
4 DR ROSSITER: Yes.
5 MR GARNHAM: So even at the second bite of the cherry we get
6 this half-hearted effort.
7 DR ROSSITER: Yes.
8 MR GARNHAM: And still no reference to the looped wire mark.
9 DR ROSSITER: No.
10 MR GARNHAM: No cross-reference of the CP form.
11 DR ROSSITER: I am not sure -- well, I think the place it
12 should have come was on one of the other blank pieces of
13 paper.
14 MR GARNHAM: I am pointing out it is a second deficiency.
15 DR ROSSITER: No, it was not there.
16 MR GARNHAM: No reference to the looped wire, first
17 deficiency.
18 DR ROSSITER: It should have appeared on the management
19 plan.
20 MR GARNHAM: Second deficiency: no reference to the looped
21 wire mark?
22 DR ROSSITER: Correct.
23 MR GARNHAM: No cross-reference to the CP form?
24 DR ROSSITER: Correct.
25 MR GARNHAM: No proper examination completed?
192
1 DR ROSSITER: Correct.
2 MR GARNHAM: No indication of who the doctor was who did the
3 examination?
4 DR ROSSITER: Correct.
5 MR GARNHAM: No signature?
6 DR ROSSITER: Correct.
7 MR GARNHAM: No date?
8 DR ROSSITER: Date, yes.
9 MR GARNHAM: Oh, we have got a date, thank you. Quite
10 right, 256, 25th July.
11 DR ROSSITER: I have the impression of somebody who started
12 something and was called away. It is very
13 extraordinary.
14 MR GARNHAM: And a very poor piece of work.
15 DR ROSSITER: Yes.
16 MR GARNHAM: Do you know who did it?
17 DR ROSSITER: I am trying to recognise the handwriting. It
18 is very curious because I do not think it is
19 Dr Reynders' handwriting, is it?
20 MR GARNHAM: We have a strange system whereby I ask the
21 questions and you answer them.
22 DR ROSSITER: Terribly sorry, I am asking myself.
23 Dr Reynders' handwriting is under "Social Issues" where
24 he has written "Sunset Gardens". So it looks to me as
25 if that is different handwriting.
193
1 MR GARNHAM: Yes, thank you. Go to page 260 in that volume,
2 please. These are the history notes.
3 DR ROSSITER: Yes.
4 MR GARNHAM: We have the entry for the 24th July.
5 DR ROSSITER: Yes.
6 MR GARNHAM: Admitted to the ward.
7 DR ROSSITER: Yes.
8 MR GARNHAM: We then have what I think are nursing notes for
9 the early part of the 25th.
10 DR ROSSITER: Yes.
11 MR GARNHAM: Then at 15.30 we have another note which
12 appears to -- these would have been completed by
13 a nurse, would they?
14 DR ROSSITER: Yes.
15 MR GARNHAM: But they appear to refer to your ward round.
16 "Anna has been in bed until about 9 o'clock. We
17 woke her up and put her in the bath. Face has been
18 oozing all day ..."
19 DR ROSSITER: "Along".
20 MR GARNHAM: "... all along the pillowcase, stained all
21 over. She had difficulty walking into the bathroom.
22 Bruises all over her body. Has felt much better after
23 her bath. Dr Rossiter has requested swabs which have
24 been done. Has also requested for proper admission and
25 photographs taken of her face."
194
1 DR ROSSITER: Yes.
2 MR GARNHAM: We have dealt with the proper admission,
3 I think.
4 DR ROSSITER: Yes.
5 MR GARNHAM: The swabs we have dealt with, because you told
6 us that was in relation to infection. Photographs take
7 of her face. Why just her face?
8 DR ROSSITER: I think this is an error. I wanted
9 photographs. Why she wrote that down, I do not know.
10 MR GARNHAM: An error by the nurse who completed this?
11 DR ROSSITER: Yes. Obviously we do photographs of
12 everything and that is what was requested.
13 MR GARNHAM: In fairness to you that was what was done,
14 eventually.
15 DR ROSSITER: Yes.
16 MR GARNHAM: But your recollection, then, is that this nurse
17 has got it wrong when she says "photographs of face"?
18 DR ROSSITER: I think so.
19 MR GARNHAM: Where do we find any indication as to who is to
20 be responsible for getting the photographs and who is to
21 be responsible for marking up the lesions?
22 DR ROSSITER: It would be done by the junior doctor and it
23 would have been done on -- well he could have written
24 the form that day. He should have written the form that
25 day, that is right, but then you have to get consent.
195
1 MR GARNHAM: Yes.
2 DR ROSSITER: In fact --
3 MR GARNHAM: So I understand your answer: there is no need
4 to assign an individual to these tasks because it is
5 automatically expected to be done by the junior doctor?
6 DR ROSSITER: It would be one of the items that is put in
7 the ward diary, saying "item to be done", then they
8 would have little boxes then they --
9 MR GARNHAM: Yes, we have seen that.
10 DR ROSSITER: Yes.
11 MR GARNHAM: It is your responsibility ultimately, however,
12 is it not, to ensure that these things happen?
13 DR ROSSITER: Oh yes.
14 MR GARNHAM: Where we find delays, for example in getting
15 the photographs done, how is that to be explained?
16 DR ROSSITER: As I recall, there were two delays: one was in
17 getting consent and the other was in contacting the
18 photographer. I do not know why there was delay in the
19 photographer coming; I was not the consultant that week.
20 It was not a matter that was brought to my attention.
21 The delay in getting the consent was with the erratic
22 visiting by Kouao.
23 MR GARNHAM: When you completed your discharge form you
24 explained the delay in getting the photographs.
25 DR ROSSITER: Yes.
196
1 MR GARNHAM: By saying "staffing problems".
2 DR ROSSITER: I think it was something to do with the
3 photographer being away, or something like that. Maybe
4 he had had some days off? I just do not know.
5 MR GARNHAM: How long would it normally take to get
6 photographs in these sort of circumstances?
7 DR ROSSITER: To be taken?
8 MR GARNHAM: To be produced back to you.
9 DR ROSSITER: Ahh. Then they would be developed when the
10 roll was finished and it would usually be within one to
11 two weeks. I really did not keep a record of it. And
12 they would then be available for me for whatever
13 meetings I went to.
14 MR GARNHAM: So the expectation, when you indicated you want
15 photographs done --
16 DR ROSSITER: I was not expecting to see them back during
17 the admission, necessarily.
18 MR GARNHAM: You anticipate me correctly. What, then, is
19 their use?
20 DR ROSSITER: Well it is more documentation when we come to
21 any child protection meetings or the courts or any
22 prosecution.
23 MR GARNHAM: I see. So it is the best form of record for
24 some future and other purpose rather than clinical?
25 DR ROSSITER: Yes.
197
1 MR GARNHAM: In your statement you refer to the notes that
2 we see on that page of the history to the effect that
3 you saw Kouao.
4 DR ROSSITER: Yes.
5 MR GARNHAM: But you tell us you now have no recollection of
6 that.
7 DR ROSSITER: I do not remember it, no, but if it says I saw
8 her I saw her.
9 MR GARNHAM: Would you not normally make a note of what she
10 told you?
11 DR ROSSITER: I would, had there been anything that was
12 different from what had already been recorded. I should
13 have done so anyway.
14 MR GARNHAM: Again, you rightly anticipate my questions.
15 And you did not?
16 DR ROSSITER: No.
17 MR GARNHAM: And you should have done?
18 DR ROSSITER: Yes.
19 MR GARNHAM: It may sound as if the point I am putting to
20 you about recording information is just some
21 bureaucratic nicety, but you understand it is not, do
22 you not?
23 DR ROSSITER: The point is absolutely taken and we have been
24 rigorously making sure that our junior doctors do it in
25 rather prolonged ward rounds.
198
1 MR GARNHAM: Not just for your junior doctors, I mean it is
2 for you as well to ensure that it is done.
3 DR ROSSITER: It is for me to ensure that it is done and it
4 means we do spend longer at each bedside with the
5 inevitable consequences with the clinical workload.
6 MR GARNHAM: The absence of any record of conversation
7 between you and Kouao can suggest only two things: one
8 that it was not recorded or, alternatively, that it did
9 not happen?
10 DR ROSSITER: It happened if Nurse Selby said it happened,
11 and she says it did. "Also interviewed by Dr Rossiter".
12 I am not sure I would call it an interview but
13 I certainly had a conversation.
14 MR GARNHAM: In English?
15 DR ROSSITER: Yes.
16 MR GARNHAM: And she was able to manage that conversation in
17 English?
18 DR ROSSITER: I do not recall it being a problem but then
19 I do not recall the conversation. So it could have been
20 fairly limited.
21 MR GARNHAM: Thank you. You speak to Kouao. Do you speak
22 to Victoria?
23 DR ROSSITER: On that occasion no. On my second week she
24 was always around. I did not have a structured
25 interview with her but I would have had a conversation
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1 with her, the same as one would with any child. In
2 fact, probably more so because of her attention-seeking
3 with adults.
4 MR GARNHAM: Did you have that conversation in English or
5 French?
6 DR ROSSITER: English.
7 MR GARNHAM: And how was her English?
8 DR ROSSITER: Enough to play and to do drawings and school
9 work with the play therapist.
10 MR GARNHAM: But not enough for you to take a clear history
11 from her?
12 DR ROSSITER: No.
13 MR GARNHAM: And no clear history was ever taken from her?
14 DR ROSSITER: No.
15 MR GARNHAM: Why not?
16 DR ROSSITER: I am not sure that it occurred that it was
17 appropriate or needed to be done. What we normally do
18 with children is we listen to them and that information
19 comes from their own nurse or their play therapist who
20 then writes it down as it comes as part of conversation
21 with a child. We do not -- sometimes we interview
22 children. It depends.
23 MR GARNHAM: That is much less likely to happen if the
24 child's first language is French?
25 DR ROSSITER: Yes.
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1 MR GARNHAM: Furthermore, Dr Forlee told us that she had it
2 in mind that Victoria would be interviewed through an
3 interpreter as soon as she got to the ward.
4 DR ROSSITER: Not on a Sunday she would not.
5 MR GARNHAM: As it turned out, not on any day.
6 DR ROSSITER: No.
7 MR GARNHAM: Would that not have been what ought to have
8 happened?
9 DR ROSSITER: I am not quite sure where Dr Forlee would get
10 that opinion from. I wonder whether she was guessing.
11 MR GARNHAM: I wonder if you could look please at volume 49,
12 page 336. This is a transcript of your evidence to the
13 Central Criminal Court.
14 DR ROSSITER: Yes.
15 MR GARNHAM: When you were asked -- and we ought to perhaps
16 start at 335, at the foot of that page, letter "g" --
17 when you were asked about taking histories from Kouao
18 and Victoria, you know from the records that a history
19 has been taken from Kouao. We see all those. "I have
20 seen the record taken by Dr Forlee. I am also aware
21 that a French nurse from another ward called Lucianne
22 spoke to her, because we wanted someone to speak in
23 French ...".
24 DR ROSSITER: I think that was more clinical or social or
25 child friendly purposes. I do not believe I expected
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