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Archived Transcript for 16 November 2001: Pages
51 to 100
51
1 you. How so?
2 DR MEATES: There may be two reasons. One because
3 Dr Rossiter was the lead clinician for child protection.
4 Dr Rossiter was contacted on that evening and that is
5 not unusual in child protection cases, even when she is
6 not on-call, and she was going to be the consultant who
7 saw Victoria the next day.
8 MR GARNHAM: She told us that she in fact took up the
9 on-call work from that evening.
10 DR MEATES: She may well have done. I cannot remember the
11 details of when she took over.
12 MR GARNHAM: If it is right that she took over as on-call
13 consultant during the course of the evening of Saturday
14 the 24th, then we need, do we not, to amend to some
15 degree your paragraph 5?
16 DR MEATES: Amend by adding something? I do not think
17 anything there is not true.
18 MR GARNHAM: It is slightly misleading, is it not, to talk
19 about you as the admitting consultant if in fact by the
20 time Victoria got to the ward Rossiter was performing
21 that role?
22 DR MEATES: The admitting consultant for the weekend and the
23 week may not be the actual consultant who is on for the
24 evening, and so in terms of whether I called myself the
25 admitting consultant from the 24th, it would not be
52
1 incorrect.
2 MR GARNHAM: So admitting consultant does not mean the
3 consultant in charge of the admission?
4 DR MEATES: No, what it means is that that consultant will
5 be the person who is available on the ward and who
6 should be the first point of contact for the care of all
7 the children in the ward, whether they have another
8 consultant or not.
9 MR GARNHAM: But at the time of Victoria's admission on to
10 Rainbow Ward it appears that Dr Rossiter was doing that
11 role, in that she told us so despite the fact that you
12 are down as the admitting consultant on the rota.
13 DR MEATES: Yes.
14 MR GARNHAM: Dr Rossiter also saw Victoria on the ward round
15 on 25th July.
16 DR MEATES: Yes.
17 MR GARNHAM: That is a consequence, is it, of the fact that
18 you and she swapped duty for that day, she becoming the
19 admitting consultant?
20 DR MEATES: She did the on-call. She would not have been
21 called the admitting consultant as such, because I was
22 going to be on for the week, so I would have continued
23 to be the admitting consultant for children admitted
24 over that weekend and the week.
25 MR GARNHAM: So if we look at the rota at 49 again, we see
53
1 that suggested at least, do we, by the amendment that
2 has been made to the consultant for Sunday 25th where
3 "Meates" is crossed out and "Rossiter" is inserted by
4 initial?
5 DR MEATES: Yes, that is the consultant on-call.
6 MR GARNHAM: What is the difference between consultant and
7 consultant admitting on this rota?
8 DR MEATES: The consultant there is the person who is
9 actually covering the ward out of hours.
10 MR GARNHAM: And the admitting consultant?
11 DR MEATES: The admitting consultant is the prime person for
12 problems on the ward during duty hours.
13 MR GARNHAM: I am sure it is me but I do not understand
14 that.
15 DR MEATES: Perhaps I can help you.
16 MR GARNHAM: Tell me the distinction between the consultant
17 and admitting consultant in terms of their job, what
18 they do.
19 DR MEATES: A consultant at any time will be available to
20 give advice to staff about admissions that have come in.
21 On-call there is only one, so after 5 o'clock.
22 MR GARNHAM: I will have to stop you because your terms are
23 immediately confusing me. When you say "a consultant",
24 do you have in mind any consultant in the hospital? Do
25 you have in mind what is called the consultant on this
54
1 list or what?
2 DR MEATES: I was referring to a paediatric consultant and
3 the consultant as referred to on this list. You talked
4 about consultant and consultant admitting and I am
5 trying to keep to those two terms so as not to confuse
6 you.
7 MR GARNHAM: I see.
8 DR MEATES: So the consultant as on this list is the person
9 who does between 5 pm and 8.30 am on week days and
10 covers the weekend 24 hours each day.
11 MR GARNHAM: Between 5.30 pm?
12 DR MEATES: 5 pm and 8.30 am.
13 MR GARNHAM: So what for the rest of us is known as the
14 night?
15 DR MEATES: Yes.
16 MR GARNHAM: So the consultant on this list does the night?
17 DR MEATES: That is right.
18 MR GARNHAM: And the admitting consultant?
19 DR MEATES: The admitting consultant may do a night during
20 that week but the admitting consultant refers to daytime
21 duties and refers to the person who is in charge. It
22 may help if I explain that at any one time there may be
23 children on the ward who are patients under four
24 different consultants long-term. It would be
25 impractical.
55
1 MR GARNHAM: Consultants of different disciplines?
2 DR MEATES: No, different paediatric consultants. So there
3 may be a patient who is a diabetic under myself, there
4 may be a patient who is a sickle cell patient under
5 Dr Rossiter, but they may all be in with acute illnesses
6 at one time. We have an admitting consultant who is the
7 one consultant who takes a lead for all acute problems
8 in the daytime during that time. The admitting
9 consultant will be somebody who is usually more
10 available and certainly never on leave. A child may
11 come in who has a long-term consultant and that
12 consultant would not be the admitting consultant but may
13 be on leave. It would be inappropriate for decisions on
14 that child to be left to the long-term consultant. They
15 would be made by one of us taking responsibility, and
16 that would be the admitting consultant.
17 MR GARNHAM: And that distinction persists even if a person
18 who is thus defined as the admitting consultant was not
19 the consultant who did the admission?
20 DR MEATES: Yes.
21 MR GARNHAM: Yes. So you in respect of Victoria take on the
22 title and role of admitting consultant even though
23 Dr Rossiter was in fact the doctor who is recorded on
24 the CP forms as being the consultant concerned with the
25 admission?
56
1 DR MEATES: Yes, and it is important for me to understand
2 who is the long-term consultant, and I did, because if
3 things came to me which should have been going to
4 Dr Rossiter, it would be my place to direct people
5 either to Dr Rossiter or for me to pass that information
6 over, but it would be very important for the ward staff
7 to have one person that they should contact for all
8 problems with ward patients, and that would be me.
9 MR GARNHAM: That would be the admitting consultant?
10 DR MEATES: That is right.
11 MR GARNHAM: Who then is in charge among the consultants for
12 Victoria's clinical care?
13 DR MEATES: For acute problems on the week that Victoria is
14 on the hospital it would be the admitting consultant.
15 MR GARNHAM: Namely you?
16 DR MEATES: In that first week. The admitting consultant
17 would not make any plans inappropriately. If there were
18 decisions that needed to be discussed with the long-term
19 consultant then it would be the admitting consultant who
20 would do that liaison and make sure that happened, but
21 there are many procedural things and acute medical
22 incidents that can be dealt with adequately by the
23 admitting consultant.
24 MR GARNHAM: Do I take it from what you say that the
25 admitting consultant retains that responsibility only
57
1 for one week?
2 DR MEATES: While they are admitting consultant. That is
3 the way the system works.
4 MR GARNHAM: If the child is in hospital for a second week
5 so that there is a different admitting consultant for
6 that second week, do they take on that role in respect
7 of that child?
8 DR MEATES: Yes, because they would be the person who has
9 the commitment allocated to ward problems. Again, if
10 they are not the long-term consultant then they would
11 liaise as appropriate with the long-term consultant.
12 MR GARNHAM: But it means that the person described as the
13 admitting consultant in respect of Victoria in her
14 second week in hospital might have been a consultant who
15 had not seen her during the first week and certainly did
16 not admit her.
17 DR MEATES: That is right.
18 MR GARNHAM: Can I then ask again my question? Who had
19 primary clinical responsibility for Victoria during that
20 first week, you or Rossiter?
21 DR MEATES: She was Dr Rossiter's patient. It was my
22 responsibility to make sure that things occurred as
23 appropriate and to liaise with Dr Rossiter about the
24 care.
25 MR GARNHAM: Who had primary clinical responsibility for
58
1 Victoria during the first week?
2 DR MEATES: She was Dr Rossiter's patient.
3 MR GARNHAM: So the answer is Dr Rossiter?
4 DR MEATES: As I said, I did have responsibility for acute
5 problems and making sure that they were handled and
6 liaising with Dr Rossiter as appropriate.
7 MR GARNHAM: So you had responsibility for acute problems
8 and Dr Rossiter had responsibility for the rest?
9 DR MEATES: Long-term plans about Victoria, if they were to
10 be made that week, would have been made in discussion
11 with Dr Rossiter. Dr Rossiter would have been the lead
12 clinician in terms of long-term plans.
13 MR GARNHAM: So Dr Rossiter is responsible for the long-term
14 plans, you are responsible for acute problems, for acute
15 concerns that arise during the time you are admitting
16 consultant, and does that cover the whole range of
17 things that might have affected Victoria?
18 DR MEATES: Yes.
19 MR GARNHAM: Things are either acute problems or they are
20 long-term plans?
21 DR MEATES: I think you are trying to oversimplify it
22 actually and making it sound more complicated than it
23 is.
24 MR GARNHAM: An interesting consequence of oversimplifying
25 things, to make them sound more complicated.
59
1 DR MEATES: It does appear you are making it more
2 complicated than it is. If problems come up in the
3 first week, and that may be acute problems or it may be
4 long-term problems, I would be the point of contact.
5 I would refer long-term problems to Dr Rossiter.
6 MR GARNHAM: I see. Let me put the question to you
7 straight. When Dr Rossiter gave evidence to the
8 Old Bailey at the trial of Kouao and Manning she said
9 that you had the main clinical care of Victoria during
10 the first week. Is that right?
11 DR MEATES: The clinical care during that week, I would have
12 been the first point of contact, yes.
13 MR GARNHAM: It will be obvious that this is not exactly
14 crystal clear to me. It may be that I am the only one
15 in the room who is having that difficulty but it does
16 sound a rather Byzantine arrangement, this.
17 DR MEATES: What exactly do you mean by that?
18 MR GARNHAM: Over elaborate, involved, complicated,
19 difficult to see through.
20 DR MEATES: No, it is relatively straightforward. For the
21 staff wanting to deal with a problem with a patient on
22 the ward, they have one point of call which is the
23 admitting consultant or the consultant on the ward for
24 that week, who will be identified on a rota like this as
25 admitting consultant. It is then up to the admitting
60
1 consultant to liaise as appropriate with long-term
2 consultants.
3 MR GARNHAM: My misunderstanding may stem simply from this
4 point, and that is the use of the word "admitting
5 consultant". The admitting consultant on any one day is
6 the doctor listed on the rota. You do not need, am
7 I right, to go back to the day of admission and look to
8 see who was the admitting consultant for that patient?
9 DR MEATES: No, you initially referred to consultant and
10 admitting consulant and I have tried to be consistent
11 and refer to the same things. We would call it
12 consultant on for the week. The people who make the
13 rota summarise that by calling it "consultant
14 admitting", but that does not mean that that is the
15 consultant who was on when the child was admitted.
16 MR GARNHAM: You realise why I use that expression because
17 I took it from the NMH rota but our understanding ought
18 to be that admitting consultant does not mean the
19 consultant who admitted that patient, it is the
20 consultant who is dealing with acute cases during that
21 day or week?
22 DR MEATES: It is usually a week, the acute consultant on
23 the ward for that week.
24 MR GARNHAM: Although it does change a little so that you
25 may not get the same consultant on for the whole seven
61
1 days, because you may swap for a day?
2 DR MEATES: You may swap a night on-call. It would be
3 unusual to swap a day as person on for the acute week.
4 As the consultant who is on for the week, who is
5 responsible for the patients that week, they will do the
6 discharge summaries of children admitted during their
7 week. That is the responsibility that that consultant
8 takes.
9 MR GARNHAM: Thank you for that. Do I understand your
10 evidence then that the junior doctors and nurses and the
11 other medical staff in the hospital understand this
12 arrangement?
13 DR MEATES: Yes.
14 MR GARNHAM: You were not involved with Victoria on the 24th
15 or 25th?
16 DR MEATES: Or the 26th.
17 MR GARNHAM: Furthermore, on the 26th you did not attend the
18 psychosocial ward meeting?
19 DR MEATES: No, I had another commitment.
20 MR GARNHAM: If you had been present in the NMH would you
21 have attended that psychosocial ward meeting?
22 DR MEATES: I was present at the hospital but I had
23 a commitment.
24 MR GARNHAM: You had a clinic?
25 DR MEATES: No, I was present at a major incident planning
62
1 meeting that the hospital was running.
2 MR GARNHAM: Had you not been doing that job would you have
3 attended the psychosocial meeting?
4 DR MEATES: As consultant on for that week, yes.
5 MR GARNHAM: And the reason you would do that is not because
6 of any one particular case but because of that general
7 responsibility?
8 DR MEATES: Because of the general responsibility, yes.
9 MR GARNHAM: Your first contact with Victoria was on the
10 27th?
11 DR MEATES: That is right.
12 MR GARNHAM: You saw her on the ward round?
13 DR MEATES: Yes.
14 MR GARNHAM: And the notes of that ward round were made by
15 Dr Alexander?
16 DR MEATES: Yes.
17 MR GARNHAM: We have them in volume 37, I think you still
18 have that volume, 262. I think the last entry on that
19 page reads "27th July ward round Meates"; is that right?
20 DR MEATES: Yes.
21 MR GARNHAM: You describe these in paragraph 8 as part of
22 your routine duties as admitting consultant, for which
23 I am going to read acute consultant, on duty.
24 DR MEATES: Yes.
25 MR GARNHAM: And that was therefore part of your ordinary
63
1 job to do ward rounds and to do this sort of ward round
2 in respect of a child like Victoria?
3 DR MEATES: That is right.
4 MR GARNHAM: You tell us that you were aware that there were
5 concerns about Victoria's scald injury and that there
6 was a suspicion that the scald might not really have
7 been self-inflicted.
8 DR MEATES: Yes.
9 MR GARNHAM: In your dealings with Victoria did it ever get
10 beyond that as regards the scald? Did it firm up one
11 way or the other whether the scald was self-inflicted or
12 not?
13 DR MEATES: It was an unusual injury. We had suspicions
14 about the injury because it is unusual for an eight year
15 old to have accidental scalds particularly on the face.
16 We were given a history by Miss Kouao about how that may
17 have happened and been self-inflicted. We may have
18 never got to the bottom of that but I think our
19 suspicions remain the same throughout.
20 MR GARNHAM: That was not quite my question. Did it ever
21 get beyond suspicion? Did you ever firm up?
22 DR MEATES: In what way do you mean firm up?
23 MR GARNHAM: Decide that in your best estimate this was
24 deliberate injury by someone else?
25 DR MEATES: I do not think we had evidence to go beyond
64
1 having a suspicion but I think the suspicion was enough
2 for us to go through child protection proceedings.
3 MR GARNHAM: Thank you. You were also aware of concerns
4 about Victoria's interaction with Kouao?
5 DR MEATES: As reported to me, yes.
6 MR GARNHAM: And you knew that the relationship had been
7 described by others as a master/servant relationship?
8 DR MEATES: I can recall that -- I do not know whether
9 master/servant had been used on that particular day but
10 certainly I am aware of that wording being used during
11 that week, but I was aware on that morning that she was
12 said to stand to attention when Miss Kouao arrived in
13 the ward.
14 MR GARNHAM: I got that from paragraph 8 of your statement.
15 Perhaps you would glance at that, where you are
16 describing the events of 27th July and you say halfway
17 through the paragraph:
18 "I was aware that the relationship had been said to
19 be a master/servant one".
20 DR MEATES: I am certainly aware of that having been
21 mentioned. I cannot recall if on that particular day
22 that is when I first heard it but certainly I have heard
23 that mentioned and I did hear that terminology mentioned
24 during the time I was on the wards that week.
25 MR GARNHAM: Would you go to the critical incident log, 275
65
1 in that volume, please. Is this where you got the
2 information from that you have just told us about?
3 DR MEATES: No, it was from the ward round. As we come to
4 patients, a discussion is held between the nursing staff
5 and the junior doctors. The junior doctors and the
6 nurses fed back to me information from the psychosocial
7 round the previous day and their individual discussions.
8 I did not look at this log.
9 MR GARNHAM: Is it not normally part of your practice to
10 read this log during the course of a ward round?
11 DR MEATES: No, not always.
12 MR GARNHAM: One might have thought simply from its title
13 "Critical Incident Log" that it would be something
14 important that a consultant in your position ought to be
15 aware of as they look at a patient, because of critical
16 incident?
17 DR MEATES: I was aware of the things that were written
18 down. I was given the information verbally. The log is
19 there as an objective and long-lasting record of what
20 was happening but I was aware of what was happening
21 because I was being told.
22 MR GARNHAM: So were you aware of all that we see now
23 recorded on that incident log, recorded as being noted
24 before the 27th July? The first two entries are the
25 ones I am particularly interested in.
66
1 DR MEATES: I am aware of the first, everything in the first
2 entry.
3 MR GARNHAM: And the second?
4 DR MEATES: The second entry I was aware that no social
5 worker had seen Victoria at the time that I was doing
6 the ward round.
7 MR GARNHAM: Were you aware that a social worker referral
8 had been made?
9 DR MEATES: I was aware that that was a plan from the
10 psychosocial meeting and because no social worker had
11 come, it was part of my plan of that day to follow that
12 up.
13 MR GARNHAM: I am going to ask you about that but were you
14 aware of what was obviously apparent to the nurses,
15 namely that the referral had been made, that there had
16 been a conversation with Karen Johns, Hospital Social
17 Worker, prior to your ward round on the 27th?
18 DR MEATES: I was aware that the social worker referral had
19 been planned from the day before. I do not know if
20 I was aware that someone had actually spoken to
21 Karen Johns before I did the ward round.
22 MR GARNHAM: Were you aware that there was a request for
23 nurses to contact the Social Work Department again if it
24 is thought injuries are non-accidental?
25 DR MEATES: I cannot recall the full conversation but I am
67
1 sure that the nurses would have made me aware of the
2 pertinent points.
3 MR GARNHAM: Were you aware that CP forms had yet to be
4 completed stating that?
5 DR MEATES: I was aware of the CP forms on my ward round.
6 MR GARNHAM: That was not my question though. Were you
7 aware that it was being suggested they had not yet been
8 fully completed?
9 DR MEATES: No, I was not aware that it was being suggested
10 they had not been fully completed because the CP forms
11 I saw looked complete.
12 MR GARNHAM: Yes, they were not entirely complete in the
13 sense that they recorded, did they not, that the doctor
14 who had completed them was unable to decide whether or
15 not this was non-accidental injury? Dr Forlee had
16 ticked the third of the three boxes.
17 DR MEATES: At the time of admission that was what she felt
18 and it was not inappropriate for her to say that.
19 MR GARNHAM: Nor did my question suggest it was.
20 DR MEATES: Can I finish?
21 MR GARNHAM: Yes, if you would answer the question.
22 DR MEATES: Well, over the next few days more information
23 came to light so that we did feel it was non-accidental
24 and that had been discussed at the psychosocial meeting
25 and that was the information that I was wanting to make
68
1 sure social services got.
2 MR GARNHAM: Which brings me back to my question. Were you
3 aware that the CP forms had not been fully completed,
4 were still vague in that important detail?
5 DR MEATES: Well, in my experience at that time you would
6 not necessarily go and amend something that had been
7 written some days before but you would certainly make it
8 clear that further information had now come to light
9 that meant that your situation, the situation had
10 changed and your decision now was much more likely that
11 this was a non-accidental injury or abusive situation.
12 MR GARNHAM: Did the Child Protection Guidelines for your
13 hospital not make it clear that the CP forms should be
14 kept up-to-date?
15 DR MEATES: They should be kept up-to-date but I do not know
16 that that means that information that has already been
17 put down there should be amended as such or whether they
18 should be kept up-to-date by further information being
19 made available.
20 MR GARNHAM: I see. In any event did you understand that
21 there was still an outstanding query, to put it at its
22 lowest, from social services about what the medical
23 opinion was in relation to Victoria?
24 DR MEATES: I had no idea what social services were thinking
25 but I was aware that we had moved from a situation of
69
1 having suspicions about physical injuries in a child to
2 now having much wider concerns regarding neglect,
3 emotional abuse, and that on top of the physical
4 injuries was making us much more certain that this was
5 an abusive situation.
6 MR GARNHAM: You told us that you were aware of the
7 discussion that had gone on on the previous day's
8 psychosocial meeting. Were you aware of that formal
9 discussion with nurses or did you see the book where
10 those notes were recorded?
11 DR MEATES: It was from the ward round discussion.
12 MR GARNHAM: I take it from that you did not see the book
13 where the notes are made about the psychosocial meeting.
14 DR MEATES: No, that book is kept in child psychiatry
15 generally.
16 MR GARNHAM: Is that not a rather inconvenient place to keep
17 it given it means you are then dependent on verbal
18 recollection of a nurse of what went on?
19 DR MEATES: It does not usually cause problems.
20 MR GARNHAM: What is the distance physically between Rainbow
21 Ward and the psychiatric department where the
22 psychosocial notes are kept?
23 DR MEATES: I am not very good at distances, I do not know,
24 300 yards.
25 MR GARNHAM: It is not something you can pop to during the
70
1 course of a ward round to get those notes?
2 DR MEATES: Not conveniently.
3 MR GARNHAM: You are as a result dependent on what the
4 nurses tell you?
5 DR MEATES: Dependent upon what the team tells us.
6 MR GARNHAM: Back if I may to the circumstances of the ward
7 round. Did you carry out a full examination of
8 Victoria?
9 DR MEATES: No.
10 MR GARNHAM: There had not been a full examination of
11 Victoria previously, had there?
12 DR MEATES: I was not aware of that.
13 MR GARNHAM: There ought to have been a full examination of
14 Victoria, ought there not?
15 DR MEATES: I had seen diagrams where her face had been --
16 of her face with injuries documented. I had seen
17 diagrams of her body where injuries had been documented
18 and I believed that that had occurred because she had
19 been examined.
20 MR GARNHAM: What do you regard as constituting a full
21 examination?
22 DR MEATES: It varies in different situations.
23 MR GARNHAM: Really?
24 DR MEATES: Yes.
25 MR GARNHAM: Explain how, please.
71
1 DR MEATES: I could have answered quickly that it is
2 examining the patient from top to toe but obviously in
3 certain circumstances you will concentrate on some areas
4 more than others.
5 MR GARNHAM: And that is still a full examination, is it?
6 DR MEATES: Yes it is a full examination, it is just that
7 some areas have a fuller examination than others but
8 a full examination is examining the patient from top to
9 toe, making some comment about their general demeanour,
10 making any comment about physical signs that you note.
11 If a child had asthma you would spend a lot more time
12 examining the chest.
13 MR GARNHAM: I understand that the particular circumstances
14 of the admission may lead you to concentrate on
15 particular parts of the body but a full examination
16 would involve, would it not, a consideration of the
17 patient from head to toe?
18 DR MEATES: That is right.
19 MR GARNHAM: Including central nervous system?
20 DR MEATES: Central nervous system in children, examination
21 varies. Sometimes you get a lot of information just by
22 looking at the child, the way they move, what they are
23 doing, the way they are playing, their demeanour. So
24 you may not do a full neurological examination as you
25 may see in an adult where you sort of document each
72
1 cranial nerve. If a child was talking, running around
2 and playing then the examination may just reflect that
3 and that would not be inappropriate.
4 MR GARNHAM: But that would mean that by that method you had
5 conducted a sufficient examination of the central
6 nervous system?
7 DR MEATES: In most cases, yes. If the child was not doing
8 those things you would need to have a more detailed
9 examination.
10 MR GARNHAM: Abdomen, expect to check for masses in the
11 abdomen?
12 DR MEATES: Usually, yes.
13 MR GARNHAM: Heart and lungs, listen to the heart?
14 DR MEATES: Yes.
15 MR GARNHAM: Listen to the lungs?
16 DR MEATES: Yes.
17 MR GARNHAM: And you would expect, would you not, even in
18 the brief form that doctors' notes often take that there
19 would be some record of the fact that such a full
20 examination had been done?
21 DR MEATES: Yes.
22 MR GARNHAM: There is no note anywhere, is there, in
23 Victoria's case of anybody doing that sort of full
24 examination?
25 DR MEATES: Can I refer to the notes before I answer that?
73
1 MR GARNHAM: Yes indeed.
2 DR MEATES: Thank you. I disagree. There is information on
3 the structured sheet, number 37, 292.
4 MR GARNHAM: Yes.
5 DR MEATES: At the bottom it says "CBS cardiovascular
6 system". It has "heart sounds" and there is a tick next
7 to the first and second, which means somebody listened
8 to the heart sound, that there were two heart sounds and
9 there was no murmur noted. On the next page --
10 MISS LAWSON: This is the year 2000.
11 MR GARNHAM: I do not mind my learned friend interrupting
12 but sometimes she takes it at precisely the wrong
13 moment. I wanted to make sure whether you were going to
14 tell us that this was a contemporaneous examination or
15 not. You will have gathered from my learned friend that
16 that is not.
17 DR MEATES: I am not quite sure. Can you refer me to the
18 correct admission note then? I have found it.
19 Certainly on the structured sheet that is not complete.
20 I just want to check the CP forms.
21 MR GARNHAM: Where are you looking at when you say the
22 structured forms?
23 DR MEATES: 250, 251, 252. There is certainly no
24 documentation on that page, you are correct. I would be
25 surprised however if nobody listened to her chest or
74
1 felt her abdomen.
2 MR GARNHAM: Whether or not they did is one question. The
3 other is whether or not it is recorded anywhere. My
4 suggestion to you and my question to you originally was
5 that there is no record of anyone carrying out a full
6 examination. That is right, is it not?
7 DR MEATES: Yes.
8 MR GARNHAM: The notes which we had described to us as being
9 the clerking notes done during Victoria's stay
10 in July/August are those at 252 which are singularly
11 incomplete and bear interesting comparison with the
12 notes that were done when Victoria was admitted in
13 a dreadful state in February. So can I return to the
14 point I was making, namely that when you did this ward
15 round there was nothing to suggest that Victoria had yet
16 been subject to a full examination?
17 DR MEATES: No.
18 MR GARNHAM: And a child who has been admitted with child
19 protection concerns jolly well should have been, should
20 she not?
21 DR MEATES: There was information relating to the child
22 protection concerns, the CP forms had been -- whether
23 they had been completed from your point of view but they
24 certainly had been filled out.
25 MR GARNHAM: That spectacularly avoids the question because,
75
1 as will be obvious from what I have said to you so far,
2 I am interested to know whether the rest of Victoria's
3 system was examined.
4 DR MEATES: I had no reason to believe that it had not been
5 and I would have been very surprised if it was not but
6 I agree that the documentation of it is poor.
7 MR GARNHAM: You had no reason to believe it had been
8 exempt, that is what ought to have happened?
9 DR MEATES: It would be very unusual for it not to have
10 happened.
11 MR GARNHAM: But in your ward round and your preparation for
12 that ward round you discover nothing to suggest that
13 there had been a full examination.
14 DR MEATES: No, the discussion actually revolved mainly
15 around the child protection concerns.
16 MR GARNHAM: Of course but that does not mean you close your
17 eyes to any other possible causes for her condition and
18 her health, does it?
19 DR MEATES: No, and I do not think I did close my eyes to
20 them. Nothing was brought to my attention that she had
21 not been examined and that there were problems in that
22 system. For example, if the nurses had said she has
23 been coughing a lot I would have examined her chest. If
24 they had noticed on her temperature, pulse and
25 respiratory chart that her pulse was elevated, I would
76
1 have examined her heart. So there is a lot of other
2 information available to me at the time that I see the
3 child that could make me feel that there were not
4 problems in the cardiovascular or respiratory system.
5 MR GARNHAM: Is the way in which Victoria was looked after
6 in those first three days typical of the way children
7 are looked after at NMH? Is it typically the situation
8 that you only do a full examination if something has
9 alerted you to a problem?
10 DR MEATES: Children usually have a full examination on
11 admission. I believe that she probably did. I think
12 the documentation is poor, as you have pointed out.
13 MR GARNHAM: Please finish.
14 DR MEATES: As the consultant doing the ward round I would
15 tend to concentrate on the area where there is a problem
16 and in this case it was Victoria's scalds. If something
17 else has been noticed, if the nurses have noticed some
18 other problems, if the temperature, pulse and
19 respiratory chart shows some variation, then obviously
20 I would look at those systems as well.
21 MR GARNHAM: You told us at some length about the
22 responsibilities that you and Dr Rossiter had in
23 relation to Victoria and you certainly had some
24 continuing clinical responsibility for her. We have
25 heard evidence not just that the notes are deficient and
77
1 there is no note of an examination, but we have heard
2 evidence that there was no full examination of Victoria.
3 DR MEATES: I am surprised by that.
4 MR GARNHAM: And that the doctor who admitted her in A&E or
5 who saw her in A&E and admitted her to the ward took the
6 view it was not appropriate for her to do a full
7 examination then and that it could be done on the ward.
8 We then hear a series of doctors who make it clear that
9 they do no such full examination. We now have the
10 consultant in charge who says, "I thought there would
11 have been." Let me ask you again, is the care that
12 Victoria got typical of what went on in the NMH at this
13 time?
14 DR MEATES: Not as you have just described, no.
15 MR GARNHAM: Because there is absolutely no doubt there
16 should have been a full clinical examination of Victoria
17 by, on or before 27th July.
18 DR MEATES: Yes.
19 MR GARNHAM: So that you could see the origin of my concern
20 I wonder if we could have the NMH Child Protection
21 Guidelines in volume 39, please. They begin at page
22 221. You are familiar with these I imagine?
23 DR MEATES: I have seen them, yes.
24 MR GARNHAM: If you go to 223, the introductory general
25 principles, under the heading "Assessment":
78
1 "In all situations where there has been an
2 allegation or suspicion that a child has been
3 ill-treated or injured, the first concern is the safety
4 of the child. All allegations must be investigated as
5 soon as possible and in the case of injury within 24
6 hours."
7 Would you agree that that is what these provisions
8 provide?
9 DR MEATES: Yes.
10 MR GARNHAM: Was that done in Victoria's case?
11 DR MEATES: Well, certainly the child protection forms were
12 filled out, it was referred to social services, she was
13 admitted for further assessment.
14 MR GARNHAM: "The child must be seen by someone competent to
15 assess the situation and to secure the child's safety if
16 necessary." It is important to register, contact key
17 workers, consult with others, to examine the child fully
18 and to assess any injuries in the light of the
19 explanations given.
20 DR MEATES: Yes.
21 MR GARNHAM: So she should have been examined fully?
22 DR MEATES: She should have been yes.
23 MR GARNHAM: "To record all observations accurately and
24 contemporaneously." Not done.
25 DR MEATES: No.
79
1 MR GARNHAM: "To record action taken and contacts with other
2 agencies".
3 DR MEATES: That was done.
4 MR GARNHAM: "To consider the position of other children in
5 the family or household who might be at risk".
6 Was consideration given to that?
7 DR MEATES: I believe on the CP forms the note of other
8 family members was that they were not in this country so
9 it was taken into consideration.
10 MR GARNHAM: You say in the penultimate sentence of
11 paragraph 8 that Dr Rossiter was always adamant that
12 Victoria had been abused and you had no reason to doubt
13 that.
14 DR MEATES: That is correct.
15 MR GARNHAM: What abuse did you believe that Rossiter was
16 adamant about? Physical, emotional, neglect, sexual?
17 DR MEATES: Victoria had come in with physical injuries
18 which had first alerted us to the possibility of abuse.
19 On top of that -- physical injuries can be very
20 difficult to prove exactly how they have occurred. On
21 top of that there was concern about neglect and
22 emotional abuse. I do not believe that I ever heard
23 Dr Rossiter being concerned about sexual abuse during
24 that admission.
25 MR GARNHAM: So what is it that Dr Rossiter was adamant
80
1 about?
2 DR MEATES: That the child was the victim of abuse.
3 MR GARNHAM: Undefined between the three categories?
4 DR MEATES: No. Definitely neglect and emotional abuse and
5 then there was the concern about the physical injury and
6 what Dr Rossiter I believe was saying was whether the
7 physical injury had been self inflicted or not it was
8 a result of poor supervision and neglect and it carried
9 the same amount of concern.
10 MR GARNHAM: How did you know what Dr Rossiter's views were?
11 DR MEATES: From -- I did speak to Dr Rossiter about it
12 during that week although I cannot remember exactly what
13 day.
14 MR GARNHAM: Do you remember whether it was before or after
15 the ward round?
16 DR MEATES: I cannot remember.
17 MR GARNHAM: You were going on to say something.
18 DR MEATES: It was also from the information that was being
19 fed back to me by the staff.
20 MR GARNHAM: You do not remember when you spoke to
21 Dr Rossiter. Do you remember what the two of you said?
22 DR MEATES: Not specifically, no.
23 MR GARNHAM: In general terms, just reflecting what you have
24 already told us.
25 DR MEATES: The impression I got from Dr Rossiter is that
81
1 she was very concerned about this child who had come in
2 with scalds and subsequently there were these other
3 concerns regarding neglect and emotional abuse which
4 added weight to our feeling that this child had been
5 abused.
6 MR GARNHAM: You had the benefit of Dr Rossiter's views but
7 did you form any independent view of the nature and
8 cause of Victoria's physical injuries?
9 DR MEATES: I thought the physical injuries were suspicious.
10 MR GARNHAM: Suspicious?
11 DR MEATES: Of being non-accidental.
12 MR GARNHAM: Yes, scalds.
13 DR MEATES: Sorry.
14 MR GARNHAM: I am sorry, I interrupted.
15 DR MEATES: I thought other information that was coming to
16 me, for example the fact that there had been a delay
17 between the injury and the attendance at A&E, added to
18 my concerns. There was information that was given to me
19 about the difference in the way the so called mother
20 Miss Kouao and Anna, Victoria were dressed at the time
21 they presented. There was the information that was
22 given to me about the interaction between the carer and
23 the child. So there was a lot of information that was
24 given to me that made me feel that this child was the
25 victim of abuse and needed child protection
82
1 investigation.
2 MR GARNHAM: Were you like Rossiter unwilling to specify
3 which category or would you have been, had you been
4 asked at the time, unwilling to specify whether it was
5 or was not physical abuse?
6 DR MEATES: It is a difficult question to ask me now because
7 I have the benefit of hindsight, so you are asking me
8 a hypothetical question.
9 MR GARNHAM: It is not quite hypothetical. I am asking you
10 to put your mind back to the position it would have
11 been. I appreciate it is a difficult question.
12 DR MEATES: I was not asked. I think I would have said
13 I thought it was very unusual for a child to receive
14 scalds on the face although not impossible to have them
15 inflicted accidentally.
16 MR GARNHAM: Did you do anything to clarify your views as to
17 whether or not this child was the victim of physical
18 abuse?
19 DR MEATES: What exactly do you mean by that?
20 MR GARNHAM: Did you make further enquiries or did you
21 simply rely on the amount of information you had got?
22 DR MEATES: That I would have felt was appropriate to be
23 covered by the one consultant who was leading and that
24 was Dr Rossiter. So for those sort of things I would
25 have felt it would be inappropriate for me to do during
83
1 that week. Unless Dr Rossiter asked me because she was
2 unable to do something, then that would have been
3 appropriate, but it would not have been appropriate for
4 me to take on the child protection concerns.
5 MR GARNHAM: Did you tell Dr Rossiter or is that implicit in
6 the arrangements that there are between you?
7 DR MEATES: It is fairly implicit. I do not think there was
8 any misunderstanding between us on that.
9 MR GARNHAM: In the last sentence of paragraph 8 you say
10 that it was your role "... to make sure that we were not
11 missing anything and that appropriate action was being
12 taken." What did that mean with regard to Victoria?
13 DR MEATES: To make sure that her health needs were being
14 met that week, for example her right eye had started to
15 swell up so it was important for me to make sure nothing
16 had been missed and that she did not have any injuries
17 on her cornea, which I did. And to make sure that what
18 needed to happen was happening, and in my view what
19 needed to be happening was that she needed to be
20 referred to social services and a child protection
21 investigation needed to occur and I believed that during
22 that week those things were put in place and were
23 happening.
24 MR GARNHAM: Do you now consider that anything was missed?
25 DR MEATES: No.
84
1 MR GARNHAM: Do you now take the view that all appropriate
2 action was taken with Victoria while she was in NMH,
3 first of all during the period with which you were
4 concerned, that first week?
5 DR MEATES: There should have been some documentation of the
6 examination but during that week, other than that, which
7 I was not aware of, other than that things proceeded
8 appropriately.
9 MR GARNHAM: Was there a full history taken on the ward from
10 Kouao?
11 DR MEATES: Not by me.
12 MR GARNHAM: By anybody?
13 DR MEATES: I believe that she was seen by -- Kouao was seen
14 by both Dr Rossiter and later there was a discussion
15 with one of the registrars when we informed her about
16 the child protection investigation.
17 MR GARNHAM: Did you see any note of a discussion with
18 Kouao?
19 DR MEATES: I did not see any note.
20 MR GARNHAM: At the time of your ward round were you not
21 concerned that there had been obtained no full history
22 from Kouao?
23 DR MEATES: I thought that there was time for that to occur
24 within the investigation.
25 MR GARNHAM: There had been some history taken from Kouao
85
1 when she was in A&E.
2 DR MEATES: That is right.
3 MR GARNHAM: But nothing on the ward.
4 DR MEATES: Not on ward rounds. She did not come in until
5 the evening usually so I actually never saw her. If
6 I had seen her then I almost certainly would have had
7 some discussions with her.
8 MR GARNHAM: What about history from Victoria?
9 DR MEATES: Well, I would not have felt it appropriate to
10 quiz Victoria on her injuries, certainly because that
11 may be stressful for her but also she did not have
12 a good understanding of English and it may have been
13 inappropriate I think.
14 MR GARNHAM: Where does the inappropriateness come from?
15 Assuming you had --
16 DR MEATES: I am not saying there should not have been
17 a discussion with Victoria but it has to be a planned
18 discussion and it should only occur once. It is not
19 something that every time someone sees the child they
20 should start quizzing her on how she got her injuries.
21 MR GARNHAM: But the simple question, "What happened to you
22 Victoria?"
23 DR MEATES: Certainly that is a question I would ask
24 children but usually children who I can communicate
25 with. I do not speak French very well.
86
1 MR GARNHAM: The problem was language?
2 DR MEATES: Yes.
3 MR GARNHAM: That aside, she should have been asked that
4 simple question?
5 DR MEATES: It was arranged that she would be asked those
6 questions and --
7 MR GARNHAM: Was it?
8 DR MEATES: She was spoken to by one of the French nurses
9 but again if you are going to have a formal inquiry of
10 the child it should be done formally and it should be
11 planned and I would have thought that all of those
12 things would have been arranged within the child
13 protection investigation and decisions would have been
14 made and that is what my expectation was, and I would
15 have felt it inappropriate for me to start quizzing that
16 child.
17 MR GARNHAM: So by social services?
18 DR MEATES: A decision would have been made and it may well
19 have been by social services. Usually in my experience
20 it would have been.
21 MR GARNHAM: But if she had been English, if she had spoken
22 English you say you would have asked her that simple
23 question, "What happened to you Victoria?"
24 DR MEATES: I would not have given her a quizzing about it.
25 I may have asked her what happened, just as I would ask
87
1 any child who was that age what had happened and why
2 they were in hospital.
3 MR GARNHAM: Quite. Did you see the marks yourself on
4 Victoria's body?
5 DR MEATES: Not on her body. I saw her scalds.
6 MR GARNHAM: Even on a ward round do you not look to see
7 after you have heard from a nurse that there are --
8 DR MEATES: The marks had been documented.
9 MR GARNHAM: You do not need to see them?
10 DR MEATES: If I had been the consultant who would later be
11 presenting evidence at a case conference then I would
12 have wanted to see them but I was not that person. The
13 marks had been documented. I did not see that there was
14 anything to be gained by undressing this little girl
15 again to look at them further.
16 MR GARNHAM: You set out your plan for Victoria at
17 paragraph 11. The first item refers to hospital social
18 workers.
19 DR MEATES: Yes.
20 MR GARNHAM: I read that as if you were not aware that the
21 hospital social worker had already been in contact. Am
22 I wrong to read it in that way?
23 DR MEATES: It starts off by saying "to ensure", and I think
24 that to me meant that I wanted to follow up something
25 that had occurred. I believed at that time that
88
1 a social worker had not seen Victoria but I was aware
2 that the plan to involve the hospital social workers had
3 been made the day before, so I wanted to follow it up.
4 MR GARNHAM: The expression "to ensure that the hospital
5 social worker was chased" suggests that there had been
6 some failure on the part of the social workers, does it
7 not?
8 DR MEATES: Not to me.
9 MR GARNHAM: Does it not? What does it mean? It means
10 what?
11 DR MEATES: It just means that that has not happened yet.
12 It is part of our plan and we need to follow it up.
13 There may be many reasons why they have not got around
14 to doing it yet but you may just want to check that
15 there is not a problem with the referral.
16 MR GARNHAM: Whose responsibility did you consider it to be
17 to contact the social workers?
18 DR MEATES: Decisions like this made on the ward round are
19 left as jobs to be completed at the end of the ward
20 round usually by either the junior doctors or the nurses
21 and that would be discussed at the end of the ward
22 round, who was going to do that.
23 MR GARNHAM: Was it discussed at the end of this ward round?
24 DR MEATES: I cannot recall what was discussed at the end of
25 this ward round.
89
1 MR GARNHAM: Is that because once you have done it the
2 consultant leaves and the junior staff divvy up the work
3 between them?
4 DR MEATES: No it is not. It is because I cannot remember
5 the discussion that occurred at the end of this ward
6 round.
7 MR GARNHAM: Could you be given volume 37 please. Page 64.
8 That is a memo -- do you have it?
9 DR MEATES: Yes.
10 MR GARNHAM: -- of 27th July, cc'd to you. Was that the one
11 you referred to earlier?
12 DR MEATES: No, I did not see this at the time. I do not
13 recall seeing this at the time of Victoria's admission.
14 I have seen it more recently with this Inquiry.
15 MR GARNHAM: Does that surprise you that a letter addressed
16 to somebody else but cc'd to you does not make it to
17 you?
18 DR MEATES: It happens.
19 MR GARNHAM: You were certainly on duty the day that would
20 have been received because you were on duty that whole
21 week.
22 DR MEATES: That is right.
23 MR GARNHAM: So there is no obvious reason why it should not
24 have got to you.
25 DR MEATES: It depends how it was sent and where it was
90
1 sent.
2 MR GARNHAM: We heard from Karen Johns, the author of that
3 letter, that there were a series of two I think chasing
4 phone calls where messages were left for you asking you
5 to ensure the amendment was done to the CP forms. Are
6 you aware of those?
7 DR MEATES: No, I am not aware of those. I do carry an
8 internal pager so at any time I can be contacted
9 directly and I was never contacted directly. Do you
10 know what days that she tried to call me?
11 MR GARNHAM: Yes, we can look at her notes. It is 37,
12 volume 5, please, if we can have that, page 255. These
13 are Karen Johns' notes, a typed-up version of her notes
14 for the 29th July. She records a telephone call to you
15 at 3.10 when she left a message and then again -- sorry,
16 I do not know the time of the first one but there are
17 two you will see there, each side of the time 10 past
18 three.
19 DR MEATES: In the morning I was in clinic, that is correct.
20 In the afternoon I am not sure where I was when she
21 telephoned but most probably I would have been on the
22 ward because I would have done a ward round in the
23 afternoon following the clinic in the morning, but as
24 I said I do carry an internal pager so can be called
25 directly at any time. I am not quite sure which number
91
1 she was phoning then either.
2 MR GARNHAM: No, I confess I did not ask her that particular
3 question. It is a little disconcerting if a social
4 worker is trying to contact you about a child like this
5 and a memo goes astray and two phone messages do not
6 reach you.
7 DR MEATES: I am not quite sure why she did not call me via
8 the internal pager which would have meant she would have
9 had a response immediately if I was on site.
10 MR GARNHAM: Again with respect that does not answer my
11 question. It is a little disconcerting, is it not, that
12 a memo cc'd to you and two telephone messages left for
13 you do not reach you, whatever bleep number she used?
14 DR MEATES: I cannot explain why it happened.
15 MR GARNHAM: It is a little disconcerting that messages like
16 that are not getting through, is it not?
17 DR MEATES: It depends on what the message was. I mean,
18 I do not know if the message was to call back or what
19 the message was that was left, but all I know is that
20 I do not know why I was not able to be contacted.
21 MR GARNHAM: Does it matter what the message is? That is
22 the point, you do not know what the message is, is it?
23 DR MEATES: It is disconcerting that another method that
24 would have ensured that I was contacted was not used,
25 yes.
92
1 MR GARNHAM: Would the sensible thing not have been for her
2 to call your secretary?
3 DR MEATES: She may well have called my secretary but I do
4 not have a full time secretary.
5 MR GARNHAM: But you have somebody who acts as your
6 secretary and I think that is what she says she did.
7 DR MEATES: Yes.
8 MR GARNHAM: And would a message left with that person who
9 acts as your secretary not have got through?
10 DR MEATES: It should do but it depends where it was left.
11 You have one here that was left at 3.10. If I was on
12 the ward until about 5, I may not have gone and checked
13 in my secretary's office before I left the hospital.
14 MR GARNHAM: The concern that this social worker had was
15 that she still did not have CP forms in a definitive
16 shape.
17 DR MEATES: Well, to be honest on the 29th July I did
18 receive communication from Karen Johns in a written form
19 and it suggested to me that there was not any problem
20 because what she says in that communication is that she
21 has referred to Haringey Social Services for a full
22 child protection investigation, so I would have taken it
23 from that communication that there was not any
24 irregularity in the referral up until that time.
25 MR GARNHAM: Is that the memo at 263 in volume 5?
93
1 DR MEATES: No, the memo at 262.
2 MR GARNHAM: I think they are identical, the only difference
3 being that you have replied on the second.
4 DR MEATES: Whatever.
5 MR GARNHAM: I think you received 263 and then wrote in
6 handwriting your answer that we find on 262.
7 DR MEATES: I am more familiar with 262 because that is the
8 one I have seen more recently.
9 MR GARNHAM: Sir, I wonder if now would be a convenient
10 moment to take a break.
11 THE CHAIRMAN: I am grateful to you. It would be helpful if
12 we could have a short break and if we get back at
13 quarter past 11.
14 (11.05 am)
15 (A short break)
16 (11.15 am)
17 MR GARNHAM: I was asking you about the memoranda passing
18 between Karen Johns and you, Doctor.
19 DR MEATES: That is right.
20 MR GARNHAM: I think you told us that you did receive the
21 memo of the 29th to which you replied with a handwritten
22 addition at 262, and can you have back volume 5 please,
23 but that you had not received the memo of the 27th --
24 DR MEATES: I do not recall seeing it.
25 MR GARNHAM: -- which we have at 267. Can I just press you
94
1 a little on that? Look at 267. Karen Johns there is
2 reminding you, it might be thought, of provisions in the
3 guidelines which require, so she asserts, full
4 completion of the CP forms. Perhaps slightly cheeky,
5 reminding you of your own hospital guidelines and
6 procedures.
7 DR MEATES: I would not have thought so. That is not my
8 impression. Cheeky, yes.
9 MR GARNHAM: Look if you will at your handwritten addition
10 to the memo of the 29th:
11 "Karen, medical photographs have been ordered but
12 not yet taken. If police want copies of them there
13 should be no problem as long as they follow the
14 procedures, which I am sure you all know."
15 It sounds that you are joining in the mild joke
16 reminding her of her procedures after she has reminded
17 you of yours.
18 DR MEATES: I can assure you I was joining in no joke. I do
19 not recall seeing the memo. It may have been because it
20 was addressed to one of the nurses that the contents of
21 it were discussed with me but certainly that last line,
22 "which I am sure you will know", was not in any way
23 meant to be cheeky or joining in any joke.
24 MR GARNHAM: I am not suggesting there was anything
25 inappropriate about this at all. What I am suggesting
95
1 is that the manner and tone of the passing notes
2 suggested you did see the memo of the 27th and that you
3 picked up the reference to procedures.
4 DR MEATES: I am sorry, I did not. Certainly some members
5 of our team may find it cheeky to receive the guidelines
6 attached to something but if I had received them in that
7 way I would not have been at all put out by that or felt
8 that it was inappropriate and certainly when I wrote
9 this it was not referring to anything that I had seen in
10 terms of procedures.
11 MR GARNHAM: And it was not intended to be, if not a joke --
12 and I do not necessarily suggest it was a joke -- it was
13 not a reply in kind if you like, talking about the same
14 matters?
15 DR MEATES: I was responding to the memo that she had
16 written me. I believed that both the police and social
17 services would be aware of procedures by which you got
18 copies of photographs.
19 MR GARNHAM: Did you tell Dr Rossiter about either of these
20 memos? You could not have told her about the first one.
21 Did you tell Dr Rossiter about the second?
22 DR MEATES: I do not know that I did actually. Because
23 I wrote on it and send it back we did not have a copy in
24 our notes.
25 MR GARNHAM: Rossiter says that you did not and you would be
96
1 prepared to accept that?
2 DR MEATES: Yes.
3 MR GARNHAM: Do you make any notes about receiving those
4 memos or what you do about them, or are we dependent
5 just on your handwritten annotation?
6 DR MEATES: I believe this was asking about a procedural
7 matter. I was the consultant for the ward that week and
8 it was not inappropriate for me to reply and I did not
9 keep a copy. I did not tell Dr Rossiter about it. It
10 would have perhaps been better if she had known but I do
11 not think it would have altered anything. It was about
12 a procedural matter about how you get photographs.
13 MR GARNHAM: The second item on the ward round plan which
14 you need to see, volume 37, page 262, is what I think
15 says "optical opinion", but I have probably
16 misinterpreted the handwriting.
17 DR MEATES: It is a shortened version of "ophthalmological".
18 MR GARNHAM: Would you with that in mind go on to 264. In
19 the second entry, 27th July, third line, there is the
20 note -- sorry, I will read the whole of it:
21 "Anna has had a good day, had breakfast, went for
22 skeletal survey and eye test. Report from eye clinic
23 normal."
24 So it looks as if that was followed up.
25 DR MEATES: Yes.
97
1 MR GARNHAM: In that context can you help us with what the
2 very top line of that page reads, 27.6.99. First of all
3 do you recognise the handwriting?
4 DR MEATES: I do not recognise the handwriting.
5 MR GARNHAM: Can you interpret the squiggles? It looks like
6 "R plus" or "RX."
7 DR MEATES: I think it is from the opthalmologist. It
8 looks -- I do not know what the earlier bit says but the
9 "VA".
10 MR GARNHAM: "Visual acute".
11 DR MEATES: Exactly, "not done" and then there is question
12 mark question mark then "cannot read". Now it may be
13 because there were problems with language and so they
14 were unable to know whether she could read the letters
15 they were asking her. That is how I would interpret
16 that.
17 MR GARNHAM: It says "does not know". What does that mean?
18 DR MEATES: I have no idea what that means.
19 MR GARNHAM: Back to the ward round notes, third entry of
20 the plan, photographs. We have heard a little about
21 that but tell us what the purpose of obtaining
22 photographs was.
23 DR MEATES: As a record of what we were seeing at the time.
24 MR GARNHAM: For clinical purposes or for ...?
25 DR MEATES: No, to be shared at the case conference and
98
1 sometimes they would, if the case conference decided
2 that the prosecution should occur then they would be
3 used in that arena.
4 MR GARNHAM: Was that purpose explained to Kouao, do you
5 know?
6 DR MEATES: The consent had been obtained. I do not know
7 exactly what had been discussed but implicit in the fact
8 that later we were doing child protection I am sure that
9 she would have under stood that.
10 MR GARNHAM: Do you know whether it was informed consent in
11 the sense of telling Kouao the purpose of it?
12 DR MEATES: As I said, I do not know what was exactly said.
13 MR GARNHAM: You tell us in your statement that the
14 reference to the photographs and the skeletal survey was
15 to make sure that they were done and organised.
16 DR MEATES: A plan had been made at the psychosocial round,
17 that they would be arranged. The consent had been
18 obtained and then it was my place to make sure that now
19 the consent had been obtained, so were the photographs
20 and the skeletal survey.
21 MR GARNHAM: So you make that endorsement on your plan on
22 your ward round and then the more junior staff will
23 follow it up thereafter, is that right?
24 DR MEATES: That is right.
25 MR GARNHAM: Do you know -- we know that because I have just
99
1 taken you to the notes, we know the optical tests were
2 done. What about the photographs and the skeletal
3 survey?
4 DR MEATES: The skeletal survey and the photographs were
5 both done. The photographs I believe on the 29th July
6 and the skeletal survey I am not sure if it is the 28th,
7 but that week any way.
8 MR GARNHAM: Could you have volume 38 please, page 156.
9 Tell us what that is first of all.
10 DR MEATES: Request for clinical photography.
11 MR GARNHAM: You complete this or it is completed on your
12 behalf?
13 DR MEATES: It was completed by one of the senior house
14 officers.
15 MR GARNHAM: Can you tell us who the signature is at the
16 bottom? It is Dr Reynders..
17 DR MEATES: David Reynders.
18 MR GARNHAM: It is he who obtains consent. Whose is the
19 signature on the right-hand side opposite Reynders?
20 DR MEATES: I do not know.
21 MR GARNHAM: And the patient's signature, is that Kouao's
22 signature or do you not know?
23 DR MEATES: I would assume it is Kouao's because the note,
24 the comment in the note says that concent was obtained
25 from her.
100
1 MR GARNHAM: You are described twice on that page as the
2 consultant. To follow through what has been
3 a discussion we had earlier, that means as you call it
4 the admitting consultant?
5 DR MEATES: Yes. A junior doctor, in any given week there
6 may be a different junior doctor on every day so they
7 will always refer to the consultant usually as the
8 admitting consultant. If the results come to me that
9 should be passed to another consultant, then that is
10 something that I would do.
11 MR GARNHAM: In fact the 29th was your last day.
12 DR MEATES: That is right.
13 MR GARNHAM: You were then going off to work in the special
14 care baby unit?
15 DR MEATES: Yes.
16 MR GARNHAM: At the same hospital?
17 DR MEATES: Yes.
18 MR GARNHAM: Did photographs come to you?
19 DR MEATES: I do not recall actually ever seeing the
20 photographs and I do not recall an envelope with
21 photographs coming to me but it may well have done. If
22 it did then I would have passed it to Dr Rossiter.
23 MR GARNHAM: The intent was when this form is filled in
24 identifying you as the consultant that the photograph
25 should be sent to you.
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