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Archived Transcript for 12 November 2001: Pages
201 to 250
201
1 Lucienne to be a witness. Sometimes --
2 MR GARNHAM: Nor to take a formal translation of an
3 interview?
4 DR ROSSITER: It happened on other occasions where we had
5 a very lonely little girl on the ward, could not speak
6 to her and we thought, "Ah, we have our Spanish speaking
7 cleaner or French midwife, why do we not ask her to
8 befriend her?"
9 MR GARNHAM: If that is right can you explain the exchange
10 that follows:
11 "Question: Another obvious source of information
12 would be the girl herself?
13 "Answer: In the notes, I see that Lucianne, our
14 nurse, took information from the girl that she had
15 poured water on her. But I see reference to a tap and
16 also reference to a kettle. So it is confusing.
17 "Question: Confusing. Was any attempt made to
18 interview this girl in the absence of her mother with
19 a French-speaking interpreter?"
20 DR ROSSITER: Not my health staff.
21 MR GARNHAM: You reply:
22 "My understanding was that Lucianne, the nurse, did
23 so."
24 What did you mean by that?
25 DR ROSSITER: I think that I misinterpreted the word
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1 "interview".
2 MR GARNHAM: I need to suggest to you that you were giving
3 the impression to the Central Criminal Court that
4 Lucienne Taub was being used for the purpose of
5 obtaining a formal translation of an interview to gain
6 a history from Victoria.
7 DR ROSSITER: I think that I was not entirely clear in my
8 evidence there.
9 MR GARNHAM: Be that as it may, the position is that no
10 attempt was made to take a history from Victoria in
11 French while she was there on the ward?
12 DR ROSSITER: No. Looking back I am not sure that I would
13 have instigated it particularly anyway because once
14 a child has been referred to social services -- and I am
15 going back to contaminating the evidence -- if we then
16 interviewed the girl it could be implied in court that
17 we had put ideas in her mind, so we would not formally
18 interview a child, we would listen to her.
19 MR GARNHAM: Can I move on to the next day, 26th July.
20 DR ROSSITER: Yes.
21 MR GARNHAM: A psychosocial ward meeting took place in the
22 afternoon of that day.
23 DR ROSSITER: Yes.
24 MR GARNHAM: You cannot recall, you tell us in your
25 statement, whether you attended?
203
1 DR ROSSITER: Looking at my diary I was free between 2 and 3
2 that day. I always went to the meetings if I could,
3 therefore it is very probably I was there.
4 MR GARNHAM: You did not regard what happened at that
5 meeting but perhaps that is not your function?
6 DR ROSSITER: It certainly did not happen as we have
7 discussed already about the shortcomings.
8 MR GARNHAM: That meeting was, I think you have told us,
9 recorded by notes taken by the SHO in psychiatry?
10 DR ROSSITER: Yes.
11 MR GARNHAM: You tell us in your statement that those notes
12 are kept in a separate book?
13 DR ROSSITER: Yes.
14 MR GARNHAM: That is the book you have talked about being in
15 the psychiatry department, is it?
16 DR ROSSITER: Yes, then brought back the next week for
17 back-reference.
18 MR GARNHAM: Nurse Norman told us yesterday -- sir for your
19 note Day 19, page 175, line 9 -- that there were no
20 separate notes, that the record was made in the main
21 nursing notes. Is that not right?
22 DR ROSSITER: I am not quite sure. Very often the nurses
23 would write down that things had been discussed or
24 possibly conclusions. What happened in Victoria's case
25 I am really uncertain, but very often nurses would
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1 record it, or indeed doctors would; discussed at
2 psychosocial ward round to refer to psychiatrist or to
3 check whether photographs have been taken, or something
4 of that nature.
5 MR GARNHAM: What is that record used for? It is kept in
6 a separate book in the psychiatry department. What was
7 it used for?
8 DR ROSSITER: I think the only thing it was used for was to
9 refer back to the following week. It really was not
10 used for anything else.
11 MR GARNHAM: If it is right, as Nurse Norman told us it was,
12 that this is a crucial element in the means by which
13 information is transferred from one agency to another,
14 it is pretty hopeless if you just stick it in a book in
15 a psychiatry department and nothing is done with it?
16 DR ROSSITER: That is why we have now made other
17 arrangements.
18 MR GARNHAM: Yes, I can well see why you would but at the
19 time why was this thought not occurring to anybody?
20 This is something vitally important, a meeting takes
21 place, notes are made and you stick it inside the book
22 in the psychiatry department.
23 DR ROSSITER: I think it is one of the facts of life that
24 one gets into a way of, "we have always done it this
25 way" and it is not until things go wrong that you
205
1 realise it is not a good method.
2 MR GARNHAM: But how did you ever think that those concerns
3 were going to get relayed to the people who you wanted
4 to react?
5 DR ROSSITER: I think I am suggesting that we did not think.
6 MR GARNHAM: It is noted in the meeting notes for that day
7 that you would examine Victoria but you tell us you were
8 unable to do so for other clinical commitments.
9 DR ROSSITER: I have been puzzling over that since your
10 opening statement. The first thing I said to myself
11 was, "What were my other commitments?" And you have
12 a list of that.
13 MR GARNHAM: Yes.
14 DR ROSSITER: I would not deliberately have not gone back
15 there. As you rightly pointed out, this was not
16 available to the people who would have reminded me, so
17 if I had forgotten nobody would have known that they
18 needed to remind me. But I also look at it the other
19 way around. Why did I need to re-examine her? Because
20 as far as I was aware, under my instructions she had
21 been re-examined by a member of my team, to whom I had
22 delegated a task which I regularly delegated to a senior
23 house officer. So I have gone round in circles to try
24 and explain what that was about. In retrospect, of
25 course it would have been valuable if I had seen her.
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1 But at the time I still do not quite understand why it
2 was felt to be important.
3 MR GARNHAM: Would it have been commonplace, then, for the
4 senior consultant like yourself to be dealing with
5 a case of suggested child abuse like this and never to
6 have examined the whole of the child's body?
7 DR ROSSITER: Oh yes, because the senior house officers are
8 told that it is their function to document, in other
9 words you do the documentation, you are the witness to
10 fact and I will comment on it.
11 MR GARNHAM: I understand why that is so and I can
12 understand why a busy consultant like yourself would not
13 have the time to spend writing up the notes.
14 DR ROSSITER: Yes.
15 MR GARNHAM: My question is not for this purpose for the
16 presentation of notes but for the process of looking at
17 the child and coming to some view about what had
18 happened to her.
19 DR ROSSITER: Well, I expect that was the intention of the
20 meeting.
21 MR GARNHAM: Yes.
22 DR ROSSITER: But for some reason, which I cannot work out,
23 I did not do so.
24 MR GARNHAM: I thought you were telling us in fact you
25 cannot now see why it was important you examined her
207
1 because you delegated that?
2 DR ROSSITER: Well, it was important but not essential.
3 MR GARNHAM: If this case had gone to court in late August
4 1999 on an allegation of child abuse and you had been
5 called as a prosecution witness, what possible value
6 would you have, having never examined the child?
7 DR ROSSITER: But it does happen. I have a case at present
8 where I have records made by the trainees. I have been
9 shown the photographs and I am being asked to write
10 a statement this weekend on the basis of the CP forms
11 plus the photographs. So it does happen.
12 MR GARNHAM: It presumes that the photographs will be
13 developed in time for whenever the crucial moment comes?
14 DR ROSSITER: Yes, because I would be asked for a court
15 report or the police officer would ask me for a witness
16 statement and what would usually happen is we would look
17 at the pictures together.
18 MR GARNHAM: And it assumes the photographs miss nothing?
19 DR ROSSITER: No. I think that they are adjunct and very
20 often a photograph will show a different aspect from
21 what the naked eye shows, from what diagrams show.
22 MR GARNHAM: Precisely. So why on earth, if you feel that
23 you may need to give evidence on a subject, do you not
24 examine the patient? I am afraid it would be my first
25 question in cross-examination if I was defending
208
1 somebody on a charge and you were called as a witness
2 "Did you examine this patient?"
3 DR ROSSITER: "Time constraint" is very lame.
4 MR GARNHAM: It certainly is lame but is it the only one you
5 can offer?
6 DR ROSSITER: It is the only one I can offer.
7 MR GARNHAM: And that in circumstances where according to
8 your diary you had nothing booked for the hour between 2
9 and 3 o'clock and where it had been noted you were going
10 to examine this patient?
11 DR ROSSITER: It may sound like a non-sequitur but I had
12 several other child protection cases in my mind at the
13 time and there was one particularly complicated one
14 where I actually was writing to just about every
15 hospital in London trying to get things together and
16 I think that my mind was concentrating on priorities and
17 it may well have been that this other case was
18 a priority to need my skills while Victoria was in the
19 ward and I thought safe.
20 MR GARNHAM: Why not come back, then, and examine Victoria
21 later?
22 DR ROSSITER: Maybe I forgot.
23 MR GARNHAM: When you were next on duty after the 26th?
24 DR ROSSITER: The Friday.
25 MR GARNHAM: That is the 30th?
209
1 DR ROSSITER: Yes.
2 MR GARNHAM: Given that there was going to be that delay if
3 you did not examine her on the 26th, why not indicate to
4 Dr Meates, who I think was responsible for her care in
5 the meantime, that she should examine her?
6 DR ROSSITER: I am not sure that the conclusion that
7 a doctor consultant should re-examine her was as clear
8 in my mind as it was in the notes. So without the memo
9 saying a consultant should see, there was no prompt to
10 do so. I think it just did not have that priority in my
11 mind, even though it was documented that it should
12 happen.
13 MR GARNHAM: I want to be clear what you are saying about
14 that. Are you saying that you now accept that such an
15 examination should have taken place?
16 DR ROSSITER: In retrospect, yes.
17 MR GARNHAM: Again I want to understand what you mean. I do
18 not want your answer knowing what happened to Victoria.
19 DR ROSSITER: Yes.
20 MR GARNHAM: I want your answer knowing what you now think
21 is proper practice. Should you have examined Victoria
22 during that week?
23 DR ROSSITER: I am sure I should.
24 MR GARNHAM: And your failure to do so you explain in
25 essence by time constraints?
210
1 DR ROSSITER: Not just physical time constraints but also
2 time constraints in my mind that I was juggling a lot of
3 cases and trying to prioritise.
4 MR GARNHAM: You tell us there was no hospital social worker
5 at the meeting that afternoon and it was the job of the
6 SHO or the registrar to inform them of what happened.
7 DR ROSSITER: Often the nurses inform, but a member of the
8 team, yes.
9 MR GARNHAM: Well whose job is it, Doctor?
10 DR ROSSITER: We quite often say you do this or you do that.
11 It is often decided in the meeting who is going to do
12 it.
13 MR GARNHAM: It is essential that the task be given to
14 someone otherwise each person will not do it.
15 DR ROSSITER: There is not a set format. It is usually
16 "Okay, I will do this", or someone says "No, I will do
17 it".
18 MR GARNHAM: So if you could remember what went on at this
19 meeting that you think you went to but cannot be sure,
20 you would have been able to tell us who it was who had
21 been given this job?
22 DR ROSSITER: Yes.
23 MR GARNHAM: The referral is in volume 5, page 246, please.
24 Is that the totality of information supplied to social
25 services at that stage?
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1 DR ROSSITER: I will need some time. I have not seen this
2 before.
3 MR GARNHAM: Please take some time.
4 Sir it does occur to me that you may want to break
5 for five minutes this afternoon and that might be
6 a convenient moment and Dr Rossiter could look at this
7 document while we break.
8 THE CHAIRMAN: That would be fine. Thank you very much
9 indeed. I think that is very thoughtful. I think we
10 would need a ten-minute break because we may go on a bit
11 later than we would normally sit. So if we get back
12 here -- the clock at the back there shows that it is
13 3.47. If we get back at 3.57 ladies and gentlemen
14 I would be grateful.
15 (3.47 pm)
16 (A short break)
17 (3.57 pm)
18 MS BOYE: Sir, can I just mention that Mr and Mrs Climbie
19 have to leave again early today because of child-minding
20 problems, and would like you to know.
21 THE CHAIRMAN: It is kind of you to mention it. Do reassure
22 Mr and Mrs Climbie that I fully understand.
23 MR GARNHAM: Apart from the chance to give us all a break,
24 Doctor, the purpose of that break was to enable you to
25 look at that document and address my question as to
212
1 whether or not that was the totality of the evidence
2 available to social workers at that date, 26th July.
3 DR ROSSITER: That was when it was faxed and that is the
4 information required is on it. It says that there are
5 CP forms.
6 MR GARNHAM: So that that also could have been obtained by
7 social services but that would then be the totality of
8 the information available at that time?
9 DR ROSSITER: Yes, except of course that referral had
10 already been made to Haringey Social Services.
11 MR GARNHAM: It became apparent, did it not, that the
12 hospital social worker had not fully understood what you
13 say were your concerns?
14 DR ROSSITER: May I fast-forward to 5/251?
15 MR GARNHAM: Yes.
16 DR ROSSITER: Actually, it is the previous page, page 250.
17 I feel that Karen Johns, who is a very experienced
18 social worker, had understood enough to take to
19 a strategy meeting. It was not the totality but it
20 was -- reading this, there is certainly sufficient here
21 for it to progress to a full investigation.
22 MR GARNHAM: What is it that leads you to say that?
23 DR ROSSITER: She talks about scars. I know she says "old
24 scars" but she says there were scars and there was
25 a diagram. She knows there is a skeletal survey, she
213
1 knows there is information anyone could interpret as
2 emotional abuse and neglect. What I do find puzzling is
3 going back to 250 -- because that was on 251 -- on 250
4 she writes:
5 "Following the child protection meeting there is
6 concern (Dr Rossiter) child protection forms have been
7 completed but do not specify NAI."
8 But they do not specify not NAI and I would have
9 expected that if she was unclear whether it was NAI or
10 not, my name is exactly above that query and I would be
11 the person to have asked. To have been asked, I am
12 sorry.
13 MR GARNHAM: You are referring there to the fact that the CP
14 form in its then state, tick box 3, indicated that
15 further information was awaited?
16 DR ROSSITER: Yes. So if she wanted further information and
17 she knew that I was the consultant who was concerned,
18 and she knew that from CP1, why did she not say, "Can
19 you update me? Do you think this is NAI or is it not?"
20 upon which I am sure I would have said, "Yes, it is
21 NAI".
22 MR GARNHAM: Let us test that by looking at the letter, the
23 memorandum that was in fact sent by Karen Johns to the
24 ward at page 267.
25 DR ROSSITER: Yes.
214
1 MR GARNHAM: 27th July, from her to the sister in charge of
2 Rainbow Ward. Who do you understand that to be, by the
3 way?
4 DR ROSSITER: It would be Beat Norman if in charge,
5 otherwise the next senior nurse who is in charge,
6 Dr Meates.
7 MR GARNHAM: Copy Dr Meates.
8 DR ROSSITER: She has not given evidence yet but I know
9 I never saw that letter. So my expectation would have
10 been that had Dr Meates received it she would have given
11 it to me to reply.
12 MR GARNHAM: If you or Meates had seen it, it would have
13 been obvious, would it not, from that that the
14 impression you have just described as the one you were
15 expecting Karen Johns to be under was misplaced, because
16 it is plain from this --
17 DR ROSSITER: It says here:
18 "At present I understand that non-accidental injury
19 has not been suggested."
20 But it had been suggested, it was just we were
21 uncertain.
22 MR GARNHAM: Be that as it may, had you received this letter
23 it would have been apparent to you that there was
24 a misunderstanding in the mind of Miss Johns --
25 DR ROSSITER: Yes.
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1 MR GARNHAM: -- which you would have been obliged to
2 correct?
3 DR ROSSITER: Very quickly.
4 MR GARNHAM: But you say this memorandum never reached you.
5 DR ROSSITER: No. I do not think I saw it until after the
6 Inquiry was commenced. I do not believe I saw it even
7 before the trial and I do not believe I saw it at the
8 time of the part 8, the original part 8.
9 MR GARNHAM: You tell us that Karen Johns had taken the CP
10 forms from the ward. She had presumably taken copies?
11 DR ROSSITER: I believe it is documented in the notes. She
12 has written in the clinical notes "I have taken copies
13 of CP forms" and she has dated it.
14 MR GARNHAM: Can you help me with the date of when that was;
15 do you recall?
16 DR ROSSITER: I think it was the Tuesday or the Wednesday.
17 I could probably find it if I had the clinical file.
18 MR GARNHAM: I am, as you will understand, troubled by the
19 fact that you say that this letter did not reach you.
20 DR ROSSITER: No.
21 MR GARNHAM: What is the usual procedure if a letter like
22 this arrives on a ward? Where does it go?
23 DR ROSSITER: If it was addressed to me it would be given to
24 me.
25 MR GARNHAM: It was not addressed to you, it was addressed
216
1 to Karen Johns.
2 DR ROSSITER: It does not specify whether it is going to her
3 on the ward or to her secretary, it just says "cc", so
4 we do not know what was on the envelope.
5 MR GARNHAM: If it was delivered by hand to the ward what
6 would be done with it?
7 DR ROSSITER: It would be handed to the person it was
8 addressed to when they next turned up there, or it could
9 be put in the basket for sending notes back to the
10 secretaries.
11 MR GARNHAM: Would it ultimately find its way on to the
12 relevant file?
13 DR ROSSITER: Well it needs to get into the hands of the
14 person it is addressed to firstly.
15 MR GARNHAM: Once it has done that?
16 DR ROSSITER: It would go in the legal file.
17 MR GARNHAM: It goes in the legal file?
18 DR ROSSITER: Yes.
19 MR GARNHAM: You would have expected to find this memo on
20 the legal file if it had been received, that is where it
21 should have ended up?
22 DR ROSSITER: Yes.
23 MR GARNHAM: It appears as far as I can ascertain that that
24 is where it is.
25 DR ROSSITER: It may have found its way there now but it was
217
1 not in there -- I am as certain as I can be -- at the
2 time she was in the hospital. I mean I just do not
3 remember seeing it.
4 MR GARNHAM: You see, Dr Rossiter, it is difficult to
5 understand how it can be that this did not get through,
6 at least to the sister in charge. Can you have
7 volume 5? Do you have that? Go to page 253. These are
8 Karen Johns' notes.
9 DR ROSSITER: Yes.
10 MR GARNHAM: "Telephone call to Rainbow Ward. I spoke to
11 Sue [I think Sue Jennings], nurse in charge. Updated
12 her on the folder Haringey. Asked her to remind the
13 doctors to complete a new CP form or write their
14 comments if they suspected NAI on the existing form."
15 So that sounds as if it is being made clear to her
16 that doctors did suspect NAI, and is asking some
17 confirmation of that.
18 DR ROSSITER: I think we are in trouble of having a lot of
19 links in the chain most of which are able to break.
20 MR GARNHAM: That may be right but it is difficult to
21 understand how it can be that that sort of conversation
22 went on if the letter that we have looked at from
23 Karen Johns did not reach somebody on the ward.
24 DR ROSSITER: Well I do not understand it either but it was
25 not addressed to me.
218
1 MR GARNHAM: Can I move on to the 28th July, please. Were
2 you working that day?
3 DR ROSSITER: Yes. It will be on the list. 28th was the
4 Wednesday? Yes, I was -- you will need to check because
5 you have the list and I do not, but I was at the Royal
6 Free Hospital in the morning for the examinations and in
7 the afternoon doing haematology clinic.
8 MR GARNHAM: The diary summary you supplied us with this
9 morning says, "8.30 till 9 ward round neonatal unit
10 urgent cases".
11 DR ROSSITER: Then I have the wrong day of the week.
12 MR GARNHAM: I just want to understand what it is. That
13 would have been at which hospital?
14 DR ROSSITER: The only time I was out of the hospital --
15 well, the only time I was at another hospital was when
16 I was doing the examination at the Royal Free and
17 I think that is the Wednesday.
18 MR GARNHAM: We have a note for that for 4th August which is
19 a week later.
20 DR ROSSITER: Oh, I am so sorry.
21 MR GARNHAM: There does not seem to be any suggestion about
22 the 28th July.
23 DR ROSSITER: Sorry, I do apologise. I have my weeks
24 completely muddled. We are talking about the first week
25 I was covering the baby unit. That would be the
219
1 Wednesday, if that is the one where it says "urgent
2 cases", then we had a ward meeting and then I completed
3 the ward round. If that was a Wednesday.
4 MR GARNHAM: Ward round, neonatal unit, urgent cases.
5 DR ROSSITER: That is right because --
6 MR GARNHAM: You had been to NMH.
7 DR ROSSITER: Yes, I do apologise.
8 MR GARNHAM: There was a strategy meeting that day?
9 DR ROSSITER: Yes.
10 MR GARNHAM: It appears that no medical member attended that
11 day.
12 DR ROSSITER: Yes.
13 MR GARNHAM: You have told us I think that in those
14 circumstances medical opinion would be represented by
15 Karen Johns.
16 DR ROSSITER: Well, health anyway, because certainly in the
17 past I perceived a medical social worker as being
18 someone who understood medical jargon as opposed to any
19 social worker who would not have interaction and
20 conversations with us.
21 MR GARNHAM: Did you attempt to ensure that a member of the
22 nursing staff attended the strategy meeting?
23 DR ROSSITER: No, because as I have said before, my
24 perception was that either I went or nobody did and if
25 it was really that important that you wanted to have
220
1 hospital staff, then they should be coming to our place.
2 MR GARNHAM: Did you telephone Karen Johns that day, shortly
3 before that meeting?
4 DR ROSSITER: I do not remember. If she says I did, then
5 I did.
6 MR GARNHAM: Volume 5 again, 253.
7 DR ROSSITER: Yes.
8 MR GARNHAM: Bottom of the page:
9 "Telephone call from Dr Rossiter. Anxious
10 attachment? At least neglect, probable emotional abuse,
11 possible physical abuse."
12 DR ROSSITER: And this is the 28th.
13 MR GARNHAM: That is right.
14 DR ROSSITER: Then that was what I said, summarised.
15 MR GARNHAM: Does that note accurately reflect what you told
16 her? Do you have any other note to contradict it?
17 DR ROSSITER: I have no note to contradict it.
18 MR GARNHAM: Was that telephone conversation prompted by the
19 previous entry on that page? "Telephone call from
20 Rainbow Ward".
21 DR ROSSITER: I do not know at all.
22 MR GARNHAM: You cannot recollect how it came about that you
23 came to make that call to Karen Johns?
24 DR ROSSITER: No.
25 MR GARNHAM: Can you remember whether you ever told
221
1 Karen Johns about your concerns about the looped wire?
2 DR ROSSITER: I cannot remember.
3 MR GARNHAM: It seems, from your evidence, as if that is so
4 significant a piece of evidence that it is strange that
5 you would not have referred it to the social worker and
6 equally strange that you do not recollect doing so.
7 DR ROSSITER: Part of this is geographical, the fact that
8 I had been covering the ward for the weekend. I then
9 change my duties to not being first on as it were for
10 Victoria, but in the second week I was now covering the
11 baby unit but available for consultation. So it comes
12 further down my scale of priorities.
13 MR GARNHAM: Were you aware by the end of July that
14 Karen Johns was still awaiting amendment to the CP
15 forms?
16 DR ROSSITER: No.
17 MR GARNHAM: Because it might be thought that, perhaps, was
18 the prompt for you making the amendment to the CP3 on
19 the 1st July --
20 DR ROSSITER: No --
21 MR GARNHAM: -- 1st August.
22 DR ROSSITER: No.
23 MR GARNHAM: On 30th July you became the admitting
24 consultant.
25 DR ROSSITER: Yes.
222
1 MR GARNHAM: You do not have anything to do with Victoria
2 that day?
3 DR ROSSITER: I would have been probably in for the
4 handover. If I am on the wards, and I do not do
5 a formal ward round, I always make at least a daily
6 presence. If I have activities at 9 o'clock or 9.30
7 I go for the 8.30 handover which is done in the office,
8 looking at the list of patients with the to do book, and
9 we just go down the names and if there are any problems
10 then I hear about them. If I am not able to do that,
11 and sometimes anyway if I am on, I will call in on the
12 ward on my way home.
13 MR GARNHAM: You are describing what your usual practice is.
14 Do you have any recollection of events on that day,
15 30th July?
16 DR ROSSITER: There is no reason I would not have done it
17 but I do not have any recollection.
18 MR GARNHAM: 31st July you did a ward round with Dr Makar.
19 DR ROSSITER: Makar, yes.
20 MR GARNHAM: Do you recollect that?
21 DR ROSSITER: Not specifically, no. It was the Sunday
22 I particularly remember.
23 MR GARNHAM: No examination by you of Victoria during the
24 course of that ward round?
25 DR ROSSITER: No, because, as I explained before, in my mind
223
1 physical abuse had been fully documented. I take your
2 point that it was not but in my mind then it was and
3 I was moving on to the other concerns. You can also see
4 that I had a number of appointments that I had made out
5 of hours and I believe that my time for thinking and
6 getting my thoughts together was the Sunday.
7 MR GARNHAM: Still concentrating on the 31st July, which is
8 the Saturday.
9 DR ROSSITER: Yes.
10 MR GARNHAM: You say in paragraph 22 that you were not aware
11 at that time that as the treatment for the dermatitis
12 was working, the injuries on Victoria's body were
13 becoming more apparent.
14 DR ROSSITER: Yes, I think I was thinking of the
15 photographs.
16 MR GARNHAM: I am sure you were but that is the position;
17 that you were not aware that that was happening and
18 since you did not examine Victoria you could not become
19 aware?
20 DR ROSSITER: No.
21 MR GARNHAM: Do you have volume 37, please? Page 268.
22 Second entry:
23 "Saturday 31st July 1999, ward round with
24 Dr Rossiter." Bullet point:
25 "Skin healing, much improved".
224
1 DR ROSSITER: That would be probably reported to me by the
2 nurses. "How is Anna?" "She is fine, the skin is
3 healing."
4 MR GARNHAM: So not right to say you are not aware the
5 treatment was working?
6 DR ROSSITER: It is the way I phrased it. I knew the
7 treatment was working. I was not aware that because of
8 that it was revealing the more dramatic injuries.
9 MR GARNHAM: Did it not occur to you that that might be
10 possible; that the improved condition of her skin might
11 be revealing more dramatic injuries?
12 DR ROSSITER: I am sure it should have done but it did not.
13 MR GARNHAM: It is one of the problems with your never
14 actually doing an examination, is it, because you do not
15 get to see what is happening to Victoria's body?
16 DR ROSSITER: Agreed.
17 MR GARNHAM: You say in paragraph 24 that you recall making
18 the point to staff that Victoria's temperature was
19 "buying time for the social worker to assess her".
20 DR ROSSITER: Yes. That is not documented, it is just that
21 I remember it.
22 MR GARNHAM: Yes. What assessment was it you were
23 anticipating being done?
24 DR ROSSITER: I was expecting -- well, I did not say so in
25 so many words but a Section 47. We would then be
225
1 reported back to by the social worker with a view to
2 further action.
3 MR GARNHAM: Your view was that the Section 47 investigation
4 ought to have been up and running because of the initial
5 concerns relayed to social services?
6 DR ROSSITER: Yes.
7 MR GARNHAM: There had been no further information relayed
8 to social services about the increasing concerns you
9 had, had there?
10 DR ROSSITER: I do not know.
11 MR GARNHAM: Going over one page to page 269, we see the
12 notes of your ward round of 1st August.
13 DR ROSSITER: Yes.
14 MR GARNHAM: Those notes are made by Dr Reynders, I think.
15 DR ROSSITER: Yes.
16 MR GARNHAM: Again, same question: did you examine Victoria
17 that day?
18 DR ROSSITER: Probably not, no.
19 MR GARNHAM: Why not?
20 DR ROSSITER: Because when we have long stay patients they
21 do not get a thorough examination every day. We do if
22 there are symptoms. For instance, if you have a child
23 with asthma you would listen to the chest, look at the
24 charts but you would not strip them down and do
25 a thorough examination each day.
226
1 MR GARNHAM: You say they do not get an examination every
2 day, and one can see why that is so, but in Victoria's
3 case she did not get an examination at all except the
4 preparation of the body map on the 26th.
5 DR ROSSITER: But she is seen daily by the nurses and the
6 nurses report what they have seen on the ward round.
7 MR GARNHAM: But even when they did, it still did not prompt
8 anything more than that body map completion by Reynders.
9 No senior clinician ever examines Victoria, do they?
10 DR ROSSITER: No, there is a big gap.
11 MR GARNHAM: You tell us that you became, by that day, that
12 Sunday, aware of increasing amounts of information that
13 Victoria might be suffering emotional abuse as well as
14 neglect and physical abuse.
15 DR ROSSITER: Yes.
16 MR GARNHAM: Before I ask you about the emotional abuse,
17 what was the evidence of physical abuse by that day,
18 1st August?
19 DR ROSSITER: All that I knew or -- was about the marks that
20 I had seen and that there were diagrams showing marks
21 but they had not been thought through.
22 MR GARNHAM: The body plans that we have in the files give
23 no indication of causation.
24 DR ROSSITER: No.
25 MR GARNHAM: Your view is the fact that they are annexed to
227
1 the CP forms is enough, is it, to give those who read
2 them an indication that it was thought that these marks
3 were indicative of physical abuse?
4 DR ROSSITER: Only partly.
5 MR GARNHAM: Why do you say that?
6 DR ROSSITER: Because there should have been a further
7 comment on them. The fact that doctors were saying that
8 they thought it was a belt was not recorded anywhere.
9 MR GARNHAM: And should have been?
10 DR ROSSITER: Yes.
11 MR GARNHAM: The evidence of emotional abuse is set out in
12 that note that we have at 269. Why is self-treatment
13 with Hibitane evidence of possible emotional abuse?
14 DR ROSSITER: It was so bizarre. Here we got a child who
15 apparently had poured hot water on herself because she
16 had an itchy scalp and now, having been in the ward
17 quite some time and knowing the nurses, seemed to repeat
18 the same exercise that she went and took Hibiscrub,
19 which is a very strange thing to do, rather than going
20 to a nurse.
21 MR GARNHAM: As we have said indicative of somebody who did
22 not like to ask for help.
23 DR ROSSITER: Yes.
24 MR GARNHAM: Again that is in turn indicative of somebody
25 who might not have had help in the past, somebody who
228
1 had been subject to emotional abuse.
2 DR ROSSITER: It was just very strange behaviour.
3 MR GARNHAM: But behaviour that was pointing you in the
4 direction, was it, that the original scalding injuries
5 to the head was not physical abuse but emotional abuse?
6 DR ROSSITER: I think it was taking me down a blind alley.
7 MR GARNHAM: But that was the blind alley, was it not? You
8 were starting to think in terms of the scalding being
9 signs of emotional abuse, not signs of a physical abuse?
10 DR ROSSITER: I think that it was still reasonably open at
11 that time and still needed to be thought about, and
12 thinking about it further, I did not spend as much time
13 thinking about it then but I know it sounds like the
14 same lame excuse, but what happens in fact is that when
15 you have a multi-disciplinary meeting or you are asked
16 to do a court report or you are asked to do a witness
17 statement, then you have to sit down and think about it
18 in enormous detail, and the plain facts are that sort of
19 thinking does not always happen on a ward round, it
20 happens when you are with your various colleagues who
21 say, "Are you sure?" and question you.
22 MR GARNHAM: Are you able to take your mind back to what you
23 were thinking on 1st August, so as to answer this
24 question: what was your clinical judgment about the
25 causation of the scalding injuries at that time?
229
1 DR ROSSITER: I believe that I was taken in and I thought
2 that she had self-inflicted.
3 MR GARNHAM: Thank you. That being so, you could not have
4 expected social workers to take any different line about
5 that, could you?
6 DR ROSSITER: No. No, I think the marks on the body were
7 what were extra.
8 MR GARNHAM: But as regards the scalding injury you would
9 not criticise social workers, would you, for concluding
10 that it had been -- let me rephrase that again. You
11 would not criticise social workers for concluding that
12 the burns to the head were not indicative of physical
13 abuse, since that was your view?
14 DR ROSSITER: I think I understand you and I agree.
15 MR GARNHAM: Was that your view, despite the history of
16 delayed presentation of those symptoms?
17 DR ROSSITER: This is why I was thinking about neglect. It
18 was something very bizarre that this girl had dealt with
19 the itching in such a peculiar way and then, having done
20 so, there was delay in bringing her for medical
21 attention.
22 MR GARNHAM: So that the conclusion you are coming towards
23 is that Victoria had burned herself with the water?
24 DR ROSSITER: Yes.
25 MR GARNHAM: That that was in itself evidence of emotional
230
1 abuse?
2 DR ROSSITER: Or neglect or both.
3 MR GARNHAM: That the delay in getting her to hospital was
4 evidence of neglect?
5 DR ROSSITER: Neglect, yes.
6 MR GARNHAM: A mother who did not care?
7 DR ROSSITER: Yes.
8 MR GARNHAM: Rather than evidence, all that evidence of
9 deliberate physical abuse?
10 DR ROSSITER: Yes.
11 MR GARNHAM: That was the way your mind was working on
12 1st August?
13 DR ROSSITER: Yes.
14 MR GARNHAM: You document in a little detail the signs you
15 say of emotional abuse.
16 DR ROSSITER: Yes.
17 MR GARNHAM: Do you document anywhere the signs of neglect?
18 DR ROSSITER: Not at this stage. I was relying on the
19 initial documentation by Dr Forlee of which there was
20 quite a bit.
21 MR GARNHAM: That referred to the difference in clothing of
22 the child.
23 DR ROSSITER: And also the delay.
24 MR GARNHAM: And the delay. You tell us in paragraph 25(d)
25 that you became aware of observations that Victoria
231
1 sometimes seemed frightened in her mother's presence.
2 DR ROSSITER: Yes.
3 MR GARNHAM: What was that suggesting to you?
4 DR ROSSITER: That she was frightened, because emotional
5 abuse is low on praise and high in criticism.
6 MR GARNHAM: So this was another item of emotional abuse
7 evidence, was it? Because it might also be evidence of
8 physical abuse.
9 DR ROSSITER: It could well have been, yes.
10 MR GARNHAM: What was your thinking at the time?
11 DR ROSSITER: I think my thinking was that I did not know,
12 hence my annotation to the CP3, saying that it was abuse
13 but the category was uncertain. I think the jury was
14 out and needed to be discussed.
15 MR GARNHAM: That was the day, I think you have told us,
16 1st August, when you made the amendments to the CP3
17 form.
18 DR ROSSITER: Yes.
19 MR GARNHAM: By then, what was the evidence that left you
20 undecided? What was the evidence that suggested that
21 physical abuse was still a possible diagnosis?
22 DR ROSSITER: I only had what had happened the previous
23 weekends, plus the line diagrams.
24 MR GARNHAM: So it is the marks that are seen on the child's
25 body and recorded by Reynders?
232
1 DR ROSSITER: Yes.
2 MR GARNHAM: And what else?
3 DR ROSSITER: And the marks that I had seen which I had not
4 recorded.
5 MR GARNHAM: The looped wire, and that is it?
6 DR ROSSITER: Yes.
7 MR GARNHAM: I am not suggesting that is insignificant but
8 that is the totality of it?
9 DR ROSSITER: Yes.
10 MR GARNHAM: Why was CP3 not amended so as to make it
11 comprehensive, covering all the signs of physical abuse?
12 DR ROSSITER: You mean in general or in this case?
13 MR GARNHAM: In this case.
14 DR ROSSITER: In retrospect what should have happened, there
15 should have been a fresh CP3.
16 MR GARNHAM: I see. Which would have included reference to
17 the looped wire marks?
18 DR ROSSITER: Yes.
19 MR GARNHAM: And the other marks shown on the map?
20 DR ROSSITER: And then on CP2, under the history, could have
21 written "updated information".
22 MR GARNHAM: And why was it that that did not happen?
23 DR ROSSITER: Because it did not occur to anyone,
24 particularly not me.
25 MR GARNHAM: The danger with not doing that is twofold, is
233
1 it not: firstly, it means that that additional
2 information never reaches social services?
3 DR ROSSITER: Yes.
4 MR GARNHAM: But secondly, and perhaps even more
5 importantly, it means that social services are
6 positively being misled. Knowing that the practice is
7 to amend the CP form to include additional information,
8 if it is not amended will they not assume that that
9 accurately reflects the position?
10 DR ROSSITER: I do not think it was practice either way.
11 They were the forms; that is what happened. The forms
12 are not designed for being amended or updated. CP6,
13 which we were not using unfortunately, was how you
14 update.
15 MR GARNHAM: That may well be right but the net effect is
16 the same, is it not?
17 DR ROSSITER: Yes.
18 MR GARNHAM: That social services believe they have a full
19 picture because there is no change to the CP form, but
20 in fact they do not.
21 DR ROSSITER: What I am saying is that there is not
22 a mechanism for updating them to help social services
23 and we think that we have made a process to improve
24 that.
25 MR GARNHAM: So are you saying that social services would
234
1 know that there was no such mechanism and therefore
2 should not assume that the absence of amendment means
3 there is nothing new to add.
4 DR ROSSITER: I do not think there was any information that
5 anybody knew to have that discussion or conversation.
6 It was not something that ever came up.
7 MR GARNHAM: So social services are simply in the dark as to
8 whether there has been any development since the
9 original completion of the CP forms?
10 DR ROSSITER: The expectation of being able to update them
11 with this information -- and I am sorry to go on about
12 it -- is that we would have had a further meeting at
13 which we would be able to hear what they did not know
14 and update them with it. I am just going back to --
15 MR GARNHAM: I do not understand that. "Hear what they did
16 not know"?
17 DR ROSSITER: Yes. They are saying that they have not got
18 complete information or they did not understand
19 something so if we had had a meeting face to face, we
20 could have understood what they had misunderstood or we
21 could have recognised what they misunderstood.
22 MR GARNHAM: If it turns out that the allocated social
23 worker did receive a copy of your amendment to CP3, the
24 arrow and the words, that would not take her much
25 further forward, would it?
235
1 DR ROSSITER: Well it made sense to me but I did not know it
2 did not make sense to her.
3 MR GARNHAM: But even if she had noticed the amendment,
4 which is not a certainty since it is not flagged up,
5 even if she had noticed it, all she would have gathered
6 was that there was continuing uncertainty. She would
7 not have known it was your view, since actually it was
8 not, that there was physical abuse here.
9 DR ROSSITER: It was my view that there was physical abuse,
10 as well as the other things, and that is why I drew the
11 arrow. Now it was a very shortened way of doing it, it
12 was a diagram saying that we had changed our opinion.
13 MR GARNHAM: But you would agree with me, would you not,
14 that there was an obvious danger that the recipient of
15 that amended form might not appreciate that there had
16 been an amendment?
17 DR ROSSITER: I am not sure that the purpose of amending it
18 was for sending back to a social worker. I think it was
19 for discussion within ourselves and this is where the
20 psychosocial meeting comes round. This was for
21 gathering information with a view to sharing with social
22 services at whatever time it happened.
23 MR GARNHAM: You see the difficulty I am having with your
24 evidence, Doctor, is that it appears as if such evidence
25 as you were gathering was kept internal to the hospital,
236
1 that it was not relayed to social services by means of
2 forms, and that that did not happen because you thought
3 that it would be relayed orally?
4 DR ROSSITER: Yes. I think we were actually waiting for
5 feedback from social services to find out what they
6 wanted of us and where we went next. So we were in
7 a state of limbo really.
8 MR GARNHAM: But you knew that social services were not
9 making a practice of attending the Monday meetings, so
10 you knew that that method of communication was not
11 available.
12 DR ROSSITER: I think it is a question of timescale. The
13 girl was safe, she was in hospital, we had made
14 a referral, an assessment was being made, we were
15 waiting to hear back from them what was going to happen
16 next. In other words, the feeling was that the ball was
17 in their court rather than ours. Now that may be
18 incorrect but that is what our perception was.
19 MR GARNHAM: It does not matter where the ball is, Doctor,
20 because as you well knew on 1st August this information
21 was not reaching social services or had not thus far
22 reached social services. So to say the ball is in their
23 court is to wash your hands of any responsibility.
24 DR ROSSITER: We kept it for the pyschosocial round on the
25 Monday.
237
1 MR GARNHAM: But you know they are not going to turn up?
2 DR ROSSITER: But we then collate the information we have.
3 What are we going to do about it? We are going to ask
4 the psychiatrist to see her. Psychiatrist says, "No,
5 I want a proper social worker assessment first". So,
6 okay, we will relay back to social workers: "This is
7 where we have got to. This is our information. And by
8 the way, how are you getting on with your assessment?"
9 That was what I understood was being planned. It may
10 not be what is written down but that was my
11 understanding.
12 MR GARNHAM: Did that happen? Did you go back and say,
13 "What happened to your assessment"?
14 DR ROSSITER: Things were getting rather slow by now.
15 I think -- I mean, plans were made on the Monday. There
16 she was, her temperature was coming down, she was
17 physically well, we wanted -- we were waiting for
18 a response from the social workers to hear how they were
19 getting on with their assessment so that we could then
20 make a referral to the social worker, we were expecting
21 to reconvene the following Monday to see how we were
22 getting on. So things were getting slower but it felt
23 that she was safe.
24 MR GARNHAM: You keep referring to the fact that she was
25 safe at present.
238
1 DR ROSSITER: Yes.
2 MR GARNHAM: But it was obvious, was it not, that there was
3 going to come a time when she would cease to be safe?
4 DR ROSSITER: And I was expecting to be having some form of
5 discussion or further meeting to decide where she would
6 go.
7 MR GARNHAM: You had said that you felt that the infection
8 that you detected in Victoria's skin was buying time for
9 social services to do their assessment.
10 DR ROSSITER: Yes.
11 MR GARNHAM: But it must have become obvious to you
12 eventually that that assessment was not happening.
13 DR ROSSITER: It often is as slow as that. In fact you will
14 see that in the audit that we did in the following
15 November we were addressing just this question because
16 we were aware children were staying in hospital longer
17 than was good for them once they were physically well,
18 thus putting them at risk of intercurrent infections et
19 cetera, and it was a concern and that is why we had
20 brought it up as topic for our audit to see if we got
21 some figures to relay back. So it was a concern for
22 other children as well who got stuck on the ward for
23 quite a long time while awaiting further information
24 from the social workers.
25 MR GARNHAM: But you see the difficulty that one might have
239
1 with this evidence: that on the one hand you are
2 building up a body of knowledge relevant to whether or
3 not Victoria has been assessed, but on the other hand
4 social services in ignorance of all that information are
5 not getting on with their job. The result is that
6 nobody does anything and time marches on.
7 DR ROSSITER: May I respond that I never knew the outcome of
8 the planning meeting which I have now seen. I mean,
9 a year later. I never got a report back from the
10 strategy meeting to know what they were doing so we were
11 left rather in the dark.
12 MR GARNHAM: You tell us that because of your concerns about
13 emotional abuse you asked for a psychiatric assessment
14 to be done.
15 DR ROSSITER: Yes.
16 MR GARNHAM: When was the referral done?
17 DR ROSSITER: It was not referred because the discussion at
18 the psychosocial meeting was that the psychiatrist did
19 not want to see the child until they had further
20 background information. This is common practice in both
21 Haringey and Enfield, that if a child is being
22 interviewed or being assessed, or what have you, for
23 social concerns, they want to have as much background as
24 possible before they then take it on. That is their
25 practice.
240
1 MR GARNHAM: So, as you know, there is going to be no
2 psychiatric assessment until the social work assessment
3 is done.
4 DR ROSSITER: They had agreed in principle but were not
5 taken an official referral until they had that
6 background information.
7 MR GARNHAM: The background information never comes and
8 therefore the psychiatric assessment is never done.
9 DR ROSSITER: It would have been discussed again at the
10 Monday psychosocial meeting and we would have said,
11 "What is happening about it? What happened last week?
12 What is happening this week?"
13 MR GARNHAM: Was it discussed at that meeting? Can you go
14 to the notes of the meeting at page 69, volume 37.
15 DR ROSSITER: It may not be documented but I know it was
16 discussed.
17 MR GARNHAM: There is nothing as you rightly anticipate in
18 the notes of the psychosocial meeting on 2nd August to
19 indicate that the reference to the psychiatrist was
20 discussed, but you say you recollect it being?
21 DR ROSSITER: Yes.
22 MR GARNHAM: Another example of poor note-taking at the very
23 least.
24 DR ROSSITER: Yes. But I know it was intended on the Sunday
25 and I am 99 per cent certain I was at the meeting.
241
1 I mean, it was a follow through.
2 MR GARNHAM: It does seem strange that the hospital simply
3 sit on their hands in this position. You want
4 a psychiatric opinion done, you have not got the social
5 assessment that it is said is a necessary precursor, and
6 nothing happens. Nobody writes to social services and
7 says, "Where is the social assessment which must happen
8 before we can get this girl a psychiatric assessment?"
9 DR ROSSITER: Looking back at the notes I think that this
10 should have been explained more clearly in the letter
11 which Isobel Quinn sent -- she was the person doing
12 it -- to the social worker. It needed to be spelt out
13 in words of one syllable.
14 MR GARNHAM: Well, spelt out at all would be nice, would it
15 not?
16 DR ROSSITER: Yes.
17 MR GARNHAM: 2nd August you do a full ward round.
18 DR ROSSITER: Monday, yes.
19 MR GARNHAM: Your SHO notes in respect of Victoria that she
20 is able to discharge.
21 DR ROSSITER: It is a curious phrase. It is not one I would
22 use. I think it was a very brief resume -- well, brief
23 resume, a note of what would have been a discussion.
24 MR GARNHAM: What do you understand to have been the
25 decision on the ward round on 2nd August?
242
1 DR ROSSITER: I believe that it meant that she was
2 physically well, that she needed to go somewhere.
3 Discharge means somewhere, it does not mean home. And
4 I had in mind the frustrations of children being stuck
5 in hospital so long with regard to the audit that I had
6 said so. Ready for discharge meant we have done our
7 physical bit, now what is happening about the protection
8 plan?
9 MR GARNHAM: That is quite a lot to read into three simple
10 words, is it not?
11 DR ROSSITER: I think sometimes I talk a lot on ward rounds
12 and the SHOs just take out the bits that are important
13 to them.
14 MR GARNHAM: But that is hopeless.
15 DR ROSSITER: Yes it is.
16 MR GARNHAM: Because if what you mean by "able to discharge"
17 is physically fit, but concerned about whether she is
18 being discharged back to a place where she might be
19 hurt, "able to discharge" hardly conveys that meaning,
20 does it?
21 DR ROSSITER: I could have dictated it to her or said write
22 this down very carefully, which of course is what I did
23 on the Sunday with David Reynders, listing the concerns.
24 I certainly could have done that. More importantly,
25 I could have been at ward rounds the rest of the week
243
1 and it is a matter of deep regret that my life overtook
2 me and I did not do a proper ward round, only a call-in
3 for the rest of the week, and I think that is where the
4 fault lies.
5 MR GARNHAM: You reached the decision able to discharge,
6 despite the fact that by that date you have learned
7 something about Victoria's behaviour on the ward.
8 DR ROSSITER: Yes.
9 MR GARNHAM: Her habit of eating large quantities.
10 DR ROSSITER: Yes.
11 MR GARNHAM: Her relations with Kouao.
12 DR ROSSITER: Yes.
13 MR GARNHAM: None of that, presumably, would have affected
14 your medical decision that she was physically fit for
15 discharge?
16 DR ROSSITER: Not if she had gone to a foster carer.
17 MR GARNHAM: But it would have been relevant if what was
18 contemplated was discharge back to Kouao?
19 DR ROSSITER: Very relevant, yes.
20 MR GARNHAM: Go to volume 49 again, please.
21 DR ROSSITER: Yes.
22 MR GARNHAM: I am afraid my note is unclear so I will come
23 back to that point.
24 You go on in your statement to say you cannot
25 believe that anyone would have thought that you meant
244
1 that you wanted her to go home from that note.
2 DR ROSSITER: Yes.
3 MR GARNHAM: That is because of what passed between you and
4 the SHO on the ward round.
5 DR ROSSITER: Yes, and not just the ward round but general
6 conversation that the whole of the department, the
7 nurses and the doctors, knew this was a child protection
8 case, even if they had not written it down. She was
9 a topic of constant conversation. There was no doubt in
10 anybody's mind that this was a child protection case.
11 MR GARNHAM: And therefore that despite the fact that she
12 was physically fit for discharge, she should not be
13 discharged?
14 DR ROSSITER: Well she should be discharged somewhere that
15 was safe.
16 MR GARNHAM: And not discharged back into the care of Kouao?
17 DR ROSSITER: No.
18 MR GARNHAM: It cannot have been as generally appreciated as
19 you think it was, can it, because that is what happened?
20 DR ROSSITER: The problem is that the people on the ward
21 round on the Monday were not the people on the ward
22 round on subsequent days. This is the problem with the
23 junior doctor rota and that if a senior house officer is
24 on one day and night, at that time they would then have
25 half -- one and a half days off. So the continuity was
245
1 very poor, hence my remark that I should have been at
2 the ward rounds, that I should have been the continuity.
3 MR GARNHAM: But it is disastrous, is it not? You leave,
4 what, at the very best an ambiguous note on the record,
5 "able to discharge"?
6 DR ROSSITER: Yes.
7 MR GARNHAM: There is nobody there to tell the staff at work
8 that week that that does not mean to go home.
9 DR ROSSITER: Well there is a paediatric registrar of
10 course.
11 MR GARNHAM: Reynders?
12 DR ROSSITER: No, whichever registrar was covering the wards
13 at the time. They have not given evidence yet I think.
14 MR GARNHAM: Richardson?
15 DR ROSSITER: Yes, it would be Justin Richardson, that is
16 right.
17 MR GARNHAM: So Dr Richardson would have been aware of your
18 intention, then.
19 DR ROSSITER: Yes.
20 MR GARNHAM: So that it ought to have been impossible for
21 those responsible for Victoria's care later that week to
22 have permitted her discharge to Kouao?
23 DR ROSSITER: Not impossible, unlikely. Certainly not
24 something I would have predicted.
25 MR GARNHAM: I have now found the missing note in respect of
246
1 the volume that I asked you to look at before,
2 volume 49, page 314, please. What you had heard about
3 Victoria's behaviour on the ward you described to the
4 Central Criminal Court as being extraordinary.
5 DR ROSSITER: Yes.
6 MR GARNHAM: That is how you felt it?
7 DR ROSSITER: She was very striking. I think one of the
8 reasons that I find it difficult to remember the
9 injuries on her is that I actually remember her as
10 Victoria, I remember the little girl in the sun hat. It
11 is actually quite difficult to get that out of my mind
12 and to think about the injuries. She had such
13 a sparkling personality that you almost did not see the
14 injuries, just like if you got someone for instance with
15 a cleft lip you do not see the lip if they are somebody
16 who is a person.
17 And she was producing the behaviour that was saying
18 "I am distressed". Now this is a pattern I recognise.
19 The child who becomes ward pet, who always comes to you,
20 who is very very friendly, and yet is producing bizarre
21 behaviour, the wetting, the eating and things like that.
22 And it is a sign of emotional abuse.
23 MR GARNHAM: And it is that sort of behaviour that led to
24 your concerns that Victoria should not be discharged
25 back to Kouao?
247
1 DR ROSSITER: Yes. I also knew that being able to prove
2 emotional abuse is extremely difficult. I would refer
3 you to one of my lecture slides where I did reasons for
4 being on the Child Protection Register in 1995 and
5 I have looked at England, London and Haringey for the
6 four types of abuse and Haringey was rather above the
7 average for sexual abuse and physical abuse which would
8 not surprise you, and are considerably below for
9 emotional abuse and neglect.
10 So with that in mind, because it was a lecture
11 I gave annually, I knew that if I had to prove emotional
12 abuse and neglect it needed that bit of extra effort.
13 MR GARNHAM: Whose responsibility was it to agree the
14 discharge of Victoria from Rainbow Ward?
15 DR ROSSITER: Ultimately the consultant in charge, so me.
16 MR GARNHAM: Did you want to discuss Victoria with the
17 social worker before she was discharged?
18 DR ROSSITER: I was expecting to, yes.
19 MR GARNHAM: Did you make that clear?
20 DR ROSSITER: Not explicitly. It would appear to be good
21 practice. It had not occurred to me it would not
22 happen.
23 MR GARNHAM: So you did not want to see Victoria discharged
24 from this ward?
25 DR ROSSITER: No.
248
1 MR GARNHAM: Until at least you had had a chance to discuss
2 the matter with the person who was going to be
3 responsible for her thereafter?
4 DR ROSSITER: I wanted to know where she was going, I wanted
5 to know where she was safe and I wanted her to see
6 a psychiatrist.
7 MR GARNHAM: But none of that happened?
8 DR ROSSITER: No.
9 MR GARNHAM: Because of a failure of communication between
10 you and those responsible for Victoria during the
11 following days?
12 DR ROSSITER: Yes. I think it was just whispering angels.
13 MR GARNHAM: It was just what?
14 DR ROSSITER: Whispering angels where someone tells someone
15 et cetera, which I go back to my point that I do feel
16 responsible because I was not there on ward rounds and
17 this has been taken very much on board because we have
18 been granted another consultant by the Health Authority
19 and we are now able to free up our mornings so that if
20 it is once a week onward, we are now able to do a proper
21 daily ward round.
22 MR GARNHAM: Given your concerns about Victoria, why did you
23 not plan to have any follow-up of her after she left?
24 Because you did not think she was going to leave?
25 DR ROSSITER: That is true, yes.
249
1 MR GARNHAM: It would have been open to you, would it not,
2 to have made arrangements for her to be followed up in
3 a community by a health visitor?
4 DR ROSSITER: Yes and that is what I was expecting to happen
5 through the liaison health visitor.
6 MR GARNHAM: Or a community doctor?
7 DR ROSSITER: Not usually. No, it is not their job. It
8 would normally be a general practitioner. Somebody
9 should have had a look and made sure the burns were
10 healing and that would have been the GP.
11 MR GARNHAM: So you would have expected before she left, in
12 addition to the discussion taking place between you and
13 the social worker and provision being made for her to go
14 somewhere other than with Kouao, that a health visitor
15 should have been involved?
16 DR ROSSITER: Certainly informed, yes, and that she would be
17 the person -- the health visitor and then of course the
18 school nurse because a school aged child, usually it is
19 the liaison health visitor liaises with the school
20 nurse. You have a health visitor up to the age of 5,
21 over 5 you have a school nurse.
22 MR GARNHAM: Which is what should have happened with
23 Victoria's case?
24 DR ROSSITER: Yes.
25 MR GARNHAM: Were any arrangements made to discuss
250
1 Victoria's case with her GP?
2 DR ROSSITER: I would not routinely do so. I tend to use
3 the liaison health visitor as a conduit. It seems to
4 work better.
5 MR GARNHAM: Did you discuss Victoria's case with your named
6 nursing colleague, to arrange for health visiting
7 follow-up?
8 DR ROSSITER: I think all of us had a discussion. Exactly
9 who said "you do this and you do that", I really do not
10 remember. But I knew it was my responsibility to
11 contact social services.
12 MR GARNHAM: To contact the health visitor, who was to do
13 that?
14 DR ROSSITER: That would be done by the ward on discharge or
15 if the case came up at the Tuesday psychosocial meeting,
16 that would be the fallback, as it were. So if the ward
17 had not informed then I would do so.
18 MR GARNHAM: That afternoon, 2nd August, you attended the
19 psychosocial meeting?
20 DR ROSSITER: I believe so.
21 MR GARNHAM: By that stage still no child protection
22 assessment by social services?
23 DR ROSSITER: No.
24 MR GARNHAM: Still no psychiatric assessment for that
25 reason?
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