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Archived Transcript for 12 November 2001: Pages
251 to 269
251
1 DR ROSSITER: Yes.
2 MR GARNHAM: If the case had been referred to
3 a psychiatrist, that might have assisted, might it not,
4 in the preparation of a follow-up plan?
5 DR ROSSITER: Well, the psychiatrist would have followed up
6 if they felt they wished to, yes.
7 MR GARNHAM: But it might have helped in deciding what
8 sensible steps needed to be taken?
9 DR ROSSITER: Oh yes.
10 MR GARNHAM: Why do you not ensure that whatever is
11 necessary as a precursor for that psychiatric assessment
12 takes place?
13 DR ROSSITER: I do not know.
14 MR GARNHAM: Why do you let Victoria go home before that has
15 taken place?
16 DR ROSSITER: I did not let her go home. I mean I did
17 ultimately, but as I was not informed she was going
18 home, I could not prevent it.
19 MR GARNHAM: Would you look please at the letter you wrote
20 to Petra Kitchman which is at page 80 in volume 37.
21 Second paragraph:
22 "I never managed to speak to a social worker face to
23 face (you have heard my concerns about this) and my
24 understanding was that there would be a social
25 assessment prior to an urgent planning meeting and then
252
1 referral to our child psychiatrist."
2 DR ROSSITER: Yes.
3 MR GARNHAM: You write as if the obligation to ensure those
4 things are arranged is somebody else's.
5 DR ROSSITER: I think you can see from the tone of the
6 letter I was pretty cross and frustrated and frightened.
7 I think the context of "you have heard my concerns about
8 this" was with regard to the hospital liaison meeting,
9 the three-monthly ones, where she would have represented
10 Haringey and I would have expressed my worry that we did
11 not have a proper medical social worker as part of our
12 team --
13 MR GARNHAM: I understand that but my point is that the
14 observations about social assessment and reference to
15 the child psychiatrist makes it sound as if somebody
16 else is responsible for that but ultimately it is you,
17 is it not?
18 DR ROSSITER: Ultimately. I mean I was aware there had been
19 telephone conversations and faxes on my behalf but I was
20 waiting for feedback which I had had to do on previous
21 occasions, I had to wait.
22 MR GARNHAM: Can we look at the notes of the psychosocial
23 meeting that day, 2nd August, at page 69 of that volume.
24 Do you have those?
25 DR ROSSITER: Yes.
253
1 MR GARNHAM: We need to look at the previous page which
2 concerns another case to get the date. That, I think,
3 is the 2nd August note and that page deals with Anna, as
4 she is called.
5 DR ROSSITER: Yes.
6 MR GARNHAM: There is noted at the beginning of that:
7 "Back lesions consistent with NAI."
8 DR ROSSITER: Yes.
9 MR GARNHAM: Is that observation consistent with the
10 amendment you made to the CP form only the previous day?
11 DR ROSSITER: Yes.
12 MR GARNHAM: Explain, please.
13 DR ROSSITER: Well, it is a brief note saying that -- it
14 says what it says. I think it goes back to the
15 implications of my saying the strategy is the only thing
16 in doubt -- sorry, the category, because I was including
17 physical abuse.
18 MR GARNHAM: But is this not suggestive of a conclusion that
19 there certainly is physical abuse, the question is
20 whether there is emotional abuse as well?
21 DR ROSSITER: The fact that we do not have documented
22 actually what happened, that it was not a definite whip
23 or a definite wire or a definite belt, which means it is
24 consistent with rather than diagnostic of.
25 MR GARNHAM: Plainly, but when you completed your
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1 conclusions, when you amended the "conclusions" part of
2 the CP form, should you not have said, "There is
3 evidence consistent with physical abuse", which would
4 have meant that the category was not uncertain, the only
5 question was how many categories are relevant?
6 DR ROSSITER: I could have phrased it better because that is
7 what I actually meant.
8 MR GARNHAM: You actually meant the question is how many
9 categories are in play here?
10 DR ROSSITER: Yes, yes.
11 MR GARNHAM: Because your view in the light of that
12 observation is that physical abuse certainly was
13 apparent.
14 DR ROSSITER: Oh yes, yes.
15 MR GARNHAM: But it is troublesome, is it not, that you do
16 not relay that to social services?
17 DR ROSSITER: It is indeed.
18 MR GARNHAM: Because it means that they proceed on
19 a misapprehension?
20 DR ROSSITER: Yes.
21 MR GARNHAM: Had anybody examined Victoria's back since the
22 previous week's meeting?
23 DR ROSSITER: If you mean a medical examination that was
24 documented, no. If you mean was it seen by an observant
25 nurse when she was bathed, yes.
255
1 MR GARNHAM: That is what it means, that this appears in
2 this meeting but not in the previous notes?
3 DR ROSSITER: Trying to work that out, I think so. It must
4 have come up in discussion.
5 MR GARNHAM: But why then does a doctor not go back and look
6 at this if this originates with the nurse's
7 observations?
8 DR ROSSITER: I think the gap is that nobody realised that
9 I was thinking looped wire and they had all assumed that
10 everybody thought it was a belt, so we have a big gap in
11 documentation, as you have already pointed out.
12 MR GARNHAM: Can I ask for your clinical opinion about the
13 causes of the emotional abuse?
14 DR ROSSITER: Yes.
15 MR GARNHAM: Could it be the case that the signs of
16 emotional abuse which Victoria was exhibiting by the
17 2nd August were not the result of abuse, emotional abuse
18 by Kouao, but it was the simple consequence of the fact
19 that this little girl had been uprooted from her home
20 and family in the Ivory Coast, brought to France and
21 then to England by a complete stranger to a country
22 where she did not speak the language?
23 DR ROSSITER: We see a lot of refugee children in very sad
24 circumstances and obviously they are distressed but she
25 did stand out to all of us as being different from that.
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1 It was more.
2 MR GARNHAM: So it is your clinical opinion that the signs
3 that you observed were the consequences of emotional
4 abuse in this country?
5 DR ROSSITER: That was my understanding and that I wanted it
6 to be investigated further.
7 MR GARNHAM: Thank you. Let us move on to the 3rd August,
8 through to 6th August.
9 DR ROSSITER: Yes.
10 MR GARNHAM: You did not carry out any formal ward rounds.
11 DR ROSSITER: No. I am as certain as I can be that I called
12 in in the morning.
13 MR GARNHAM: Did anybody carry out any formal ward rounds?
14 Of Victoria, including Victoria?
15 DR ROSSITER: Well, it is puzzling, this. I had thought
16 before I went back to the timetables that the registrar
17 would be doing the ward round. I think the most likely
18 thing is because David Reynders was so experienced, we
19 would have said to him, "Will you act up and if you have
20 any problems, ask us".
21 MR GARNHAM: Act up to registrar?
22 DR ROSSITER: To registrar, yes.
23 MR GARNHAM: Do you know whether he did do those ward
24 rounds?
25 DR ROSSITER: No.
257
1 MR GARNHAM: No you do not know, or no he did not do them?
2 DR ROSSITER: I do not know. I mean he has written in the
3 notes so he must have done something.
4 MR GARNHAM: You say that you did not believe that you were
5 asked whether Victoria should go home in that period and
6 then you use the words "as opposed to being discharged
7 to a safe place".
8 DR ROSSITER: Yes.
9 MR GARNHAM: Explain to us what you mean by "discharge to
10 a safe place," please.
11 DR ROSSITER: Somewhere -- well, somewhere which was either
12 foster care or, if we were wrong in our assessment of
13 Kouao, that an assessment by the social worker and
14 police had said, "No, you are wrong, it is safe, we are
15 happy for her to go there". We were waiting to compare
16 notes.
17 MR GARNHAM: You told the Central Criminal Court -- and
18 I will take you to the note if it is necessary in
19 a moment -- that you wanted to discuss where Victoria
20 should go and in particular you expected that she should
21 be accommodated.
22 DR ROSSITER: Yes.
23 MR GARNHAM: What did you mean by that?
24 DR ROSSITER: It is the PC word for going into care.
25 MR GARNHAM: There is no reference to that being in your
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1 mind in the hospital notes that we have seen, is there?
2 DR ROSSITER: No.
3 MR GARNHAM: Would it have been possible for Victoria to be
4 accommodated without clear evidence of non-accidental
5 injury?
6 DR ROSSITER: It would need to go to a court.
7 MR GARNHAM: And you would need to support that application
8 to the court with clear evidence of non-accidental
9 injuries?
10 DR ROSSITER: Oh, yes, yes.
11 MR GARNHAM: If you had been asked you would say that you
12 could produce such evidence, could you?
13 DR ROSSITER: Yes.
14 MR GARNHAM: But you do not make that clear anywhere in the
15 notes or to social services, do you?
16 DR ROSSITER: No. I am struggling with when and where and
17 why I should have done.
18 MR GARNHAM: Well, if you are saying to the Central Criminal
19 Court that you had in mind that Victoria would be
20 accommodated, that presupposes that you would have
21 supplied evidence to the social services to support such
22 an application.
23 DR ROSSITER: Yes.
24 MR GARNHAM: But you had not supplied such evidence?
25 DR ROSSITER: No, because I had not been requested and I was
259
1 expecting there to be a further get-together, including
2 myself, to sort out a very complicated case.
3 MR GARNHAM: So the accommodation which you had in mind when
4 you gave that answer to the Old Bailey was accommodation
5 that might follow if social services happened to ask you
6 to provide your evidence relating to NAI?
7 DR ROSSITER: That is what usually happens. They say, "We
8 are going for an interim care order, can you do a court
9 report, please?"
10 MR GARNHAM: But there was not the prompt, was there, in the
11 information that had been made available to social
12 services, that could have led them, reasonably, to have
13 done that?
14 DR ROSSITER: Well, in the information which Karen Johns
15 took so skilfully to this strategy meeting and in the
16 work plan which was then formulated, even though I did
17 not have it at the time, I believe that it should have
18 led to that. I mean, I was not part of the
19 decision-making, but seeing it now it looks as though
20 Karen Johns instigated a fairly active investigation and
21 protection plan which was not carried through.
22 MR GARNHAM: And to which the hospital did not contribute as
23 it might have done?
24 DR ROSSITER: Had we been there or indeed had we had
25 a report to know what they were doing.
260
1 MR GARNHAM: Or indeed had you given thought to the matter
2 and realised that the social services did not have the
3 same information as you did?
4 DR ROSSITER: They had sufficient. They did not have
5 everything. I was not aware they did not have
6 everything but from what I have seen of Karen Johns'
7 report there was certainly plenty there to carry on.
8 MR GARNHAM: So you say although there was not as much
9 information available to social services as there was to
10 you, there was enough to prompt them to make the inquiry
11 which would have resulted in them getting the rest?
12 DR ROSSITER: That is what I believe.
13 MR GARNHAM: Did you have a telephone conversation with
14 Lisa Arthurworrey at about this stage?
15 DR ROSSITER: I know that I did. I do not remember the
16 details. If you tell me the time which I think was
17 a Tuesday morning, I can tell you I was doing
18 out-patient clinic at the time.
19 MR GARNHAM: How does that help us?
20 DR ROSSITER: Because I would not be having an in-depth
21 discussion with someone in the middle of the clinic.
22 MR GARNHAM: But you might have had some discussion with
23 her?
24 DR ROSSITER: Yes. The practice is that my secretary
25 usually fields the telephone enquiries and decides what
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1 is relevant to give to me or not and she always puts
2 social workers through because most of them are
3 requesting medical examinations and what I do not want
4 to do is to go back to my desk, find a big pile of
5 messages and someone frustratingly waiting to hear from
6 me. So it is my practice to accept phone calls.
7 MR GARNHAM: You make no note of the conversation you had
8 with Lisa Arthurworrey, do you?
9 DR ROSSITER: No, I did not. My only explanation I can
10 think of is it would not have been in my mind such
11 a significant phone call that decisions were going to be
12 made from it. I believe it was for clarification.
13 MR GARNHAM: But you are, at this stage, waiting for social
14 services to come back to you, to indicate where they
15 have got to?
16 DR ROSSITER: Yes.
17 MR GARNHAM: Here is a conversation between you and the
18 allocated social worker which is the obvious opportunity
19 for you to fill her in on all they need to know.
20 DR ROSSITER: Well, it would have been had I been at a place
21 where my mind was on Victoria and I had the notes in
22 front of me and that was at the forefront of my mind.
23 What I believe I thought was that I was having a brief
24 conversation in the middle of an out-patient clinic when
25 I was trying to concentrate on the patients who were
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1 with me.
2 MR GARNHAM: But Miss Arthurworrey does not know that, does
3 she? Do you tell her, when you speak to her, "Sorry
4 Lisa, I am not able to speak to you at the moment
5 because I am in the middle of a clinic, you will have to
6 phone back"?
7 DR ROSSITER: There are a lot of circumstances when I do, so
8 what I do not understand is why I did not realise that
9 this was a conversation of great importance and why
10 she -- no, I think that is unfair. I think that
11 I really do not understand why it achieved that status.
12 But for me, if I had realised it was something important
13 like that, I would have said, "Look, I will need to get
14 back to you. Give me your phone number". So the fact
15 that I did not means that I cannot have realised that it
16 had such import.
17 MR GARNHAM: Can we have a look at Miss Arthurworrey's notes
18 of that, please, volume 6.
19 DR ROSSITER: There are quite a lot of them, I know.
20 MR GARNHAM: I think we start with 64.
21 DR ROSSITER: Yes.
22 MR GARNHAM: "Telephone call to Dr Rossiter. Purpose: to
23 clarify the concerns in her medical report."
24 DR ROSSITER: Yes.
25 MR GARNHAM: "Informed the following: Dr Rossiter feels
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1 Anna may be subject to emotional abuse, believes she is
2 displaying evidence of anxious attachment. Informed the
3 following: Anna presents as a bright 7-year old ... On
4 admission ... dirty clothing ... not wearing underwear.
5 Interactions between child and mother were observed by
6 hospital staff."
7 DR ROSSITER: All of that page agreed.
8 MR GARNHAM: All of that page agreed?
9 DR ROSSITER: Yes. Well, except at the bottom, "The
10 hospital concerns are around these old injuries".
11 MR GARNHAM: Yes, what do you say about that?
12 DR ROSSITER: Well I think if I had heard her -- when I say
13 heard, I mean concentrated and realised the import of
14 it, that she had said old injuries, I would have said,
15 "No, they are new injuries." So I cannot have --
16 MR GARNHAM: Making sure I understand this, are you saying
17 that Miss Arthurworrey's note is inaccurate or are you
18 saying you did not realise its import?
19 DR ROSSITER: I think the latter.
20 MR GARNHAM: I think we then go back in the notes to 62.
21 Sorry, I am not sure where that goes next.
22 DR ROSSITER: 63, marks on the body, the bottom half?
23 MR GARNHAM: Yes, it is 64, so it goes:
24 "Anna's state of dress, especially given the fact
25 her mother is immaculately dressed ..."
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1 DR ROSSITER: Yes.
2 MR GARNHAM: Look through the rest of those notes, please.
3 Are you content with those?
4 DR ROSSITER: "Discussion with manager and agreed home visit
5 should be arranged before Anna is discharged so a risk
6 assessment can be carried out."
7 MR GARNHAM: Do those represent your recollection of that
8 conversation?
9 DR ROSSITER: Well, I do not recollect the conversation.
10 I recollect that it occurred but I do not recollect the
11 conversation.
12 MR GARNHAM: Sir, I have muddled up these notes and it is my
13 mistake. The bottom of 64 I think we should be looking
14 at.
15 "Dr Rossiter feels Anna may be subject to emotional
16 abuse. Believes she is displaying evidence of anxious
17 attachment."
18 Then back to 63 and we get evidence of emotional
19 attachment. Then we get to the end of 63 and we go back
20 to 62.
21 DR ROSSITER: Yes.
22 MR GARNHAM: And that conversation ends three quarters of
23 the way down the page on 62. I am sorry, it is my
24 mistake, I have misled you about that Dr Rossiter.
25 Would you take a moment to read that and ensure you are
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1 happy with what I am putting to you?
2 DR ROSSITER: I would wish I was able to dispute the top of
3 62 because I do not have records so to do. It says:
4 "Dr Rossiter is unclear whether they were caused by
5 Anne scratching herself or infection by the scratching."
6 And something about thumb marks were also observed.
7 I find it difficult to concur with that. Certainly if
8 I was asked whether she had scratched herself I could
9 have said, "Yes, she was very itchy, but we have other
10 marks as well". I do not know where the thumb marks
11 come from at all.
12 MR GARNHAM: Would you accept, looking at that note, that if
13 it is accurate -- and I appreciate you cannot positively
14 confirm it -- that there is nothing there from which
15 Miss Arthurworrey could have deduced that you expected
16 her to make arrangements to accommodate Victoria?
17 DR ROSSITER: Well, it depends on emphasis because you can
18 see that I was trying very hard to persuade her of the
19 emotional abuse and neglect and I think I put the
20 emphasis on that because I knew how difficult it was to
21 prove.
22 The other thing which may or may not be
23 a non-sequitur is that I know I have difficulty in
24 conveying quite complex ideas to people I do not know,
25 and I had never met Miss Arthurworrey. This goes for
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1 patients as well. I would not normally do a telephone
2 consultation with a patient until I met them first, so
3 that I could see them in my mind's eye and imagine their
4 body language. So I do know that a conversation that
5 I had with someone I had not met who I did not have
6 a partnership with, as it were, I would expect to have
7 difficulty in understanding what I was saying. I cannot
8 say that therefore Miss Arthurworrey misunderstood me,
9 but I think that the climate was there for her to be
10 able to misunderstand me.
11 MR GARNHAM: Thank you. I think you also accept that you
12 may have underemphasised to Miss Arthurworrey that you
13 regarded physical injury as a significant risk.
14 DR ROSSITER: I think this was because I was trying to
15 overemphasise the emotional abuse and neglect because
16 I know this is difficult to prove and persuade people of
17 because I have had difficulties in the past.
18 MR GARNHAM: Before we leave this topic, Dr Rossiter, let me
19 ask you this: did you have a conversation with
20 Lisa Arthurworrey in the witness room of the Old Bailey
21 about this conversation?
22 DR ROSSITER: All I said to her was: "Did we have
23 a conversation?" and she said yes.
24 MR GARNHAM: Do you accept that the conversation in the
25 witness room at the Old Bailey went along these lines:
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1 You said it was the most horrific child death case you
2 had had to deal with?
3 DR ROSSITER: I may well have said so.
4 MR GARNHAM: And did you say to her, Lisa Arthurworrey, "Did
5 we have a conversation about it"?
6 DR ROSSITER: I did ask her because I could not remember.
7 I think the context of the first remark was meant to be
8 friendly. I knew that it was going to be very
9 distressing for her. I had seen some of the press
10 already and I felt that I wanted her to know that I was
11 feeling for her.
12 MR GARNHAM: But did you ask her whether there had been
13 a conversation between the two of you?
14 DR ROSSITER: Yes.
15 MR GARNHAM: Because that is suggestive, is it not, of you
16 not knowing whether there had been a conversation?
17 DR ROSSITER: Certainly not remembering, yes. That is why
18 I am saying I now know we had a conversation but I did
19 not remember it at the time.
20 MR GARNHAM: I see. Because it is the case, is it not, that
21 you did not at that stage, sitting waiting to give
22 evidence at the Old Bailey, recollect this conversation
23 at all?
24 DR ROSSITER: No.
25 MR GARNHAM: No you are agreeing with me or no you are
268
1 disagreeing?
2 DR ROSSITER: I am agreeing with you, I did not recollect
3 it.
4 MR GARNHAM: Since then you have now recovered some of your
5 recollection of this conversation, have you?
6 DR ROSSITER: No.
7 MR GARNHAM: You still have no recollection of it? Because
8 I read your statement as if you do have some.
9 DR ROSSITER: No, I think the statement was implying that
10 I had become aware of it. I had not spelt it out as
11 such but my awareness was from -- well, I must have been
12 puzzled, otherwise -- I must have been puzzling to try
13 to remember whether I remembered it, if you see what
14 I mean, which is why I asked her. Otherwise it would
15 have been a very curious thing to do.
16 MR GARNHAM: Can we just look at the transcript in the
17 Old Bailey, please. Volume 49, page 306. 306 is where
18 your evidence starts.
19 DR ROSSITER: Yes.
20 MR GARNHAM: Sir, I am conscious of the fact I am starting
21 to lose the plot of this line of questioning. I am
22 afraid the day has gone on too long for me to keep on
23 going. I do not think on any basis I am going to finish
24 this witness tonight and rather than my attempting to
25 struggle on I wonder if you would consider adjourning
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1 now.
2 THE CHAIRMAN: Yes. Just before we do adjourn, Doctor,
3 earlier on today you had difficulty remembering the name
4 of a social worker. Can you now remember the name of
5 the social worker?
6 DR ROSSITER: I cannot. It must be suppressed. If I am
7 allowed to ask my colleagues I am sure they will tell
8 me.
9 THE CHAIRMAN: You are not allowed to ask your colleagues.
10 You are on oath and you are not allowed to discuss your
11 evidence with your colleagues or indeed your advocate
12 before returning tomorrow morning.
13 DR ROSSITER: I shall have to try to do my best to remember.
14 It is a function of my mature age that I have great
15 difficulties in remembering names. I hope it will come
16 to me in the night.
17 THE CHAIRMAN: Well, I hope it will. Thank you very much.
18 Ladies and gentlemen, we will adjourn until
19 10 o'clock tomorrow morning. Thank you very much.
20 (5.20 pm)
21 (Hearing adjourned until 10 o'clock the following day)
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