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Archived Transcript for 16 November 2001: Pages
101 to 150
101
1 DR MEATES: And that is not inappropriate.
2 MR GARNHAM: How long does it normally take for photographs
3 to be done?
4 DR MEATES: It may take up to a week before they come
5 through, maybe longer.
6 MR GARNHAM: If this request is made on the 29th, the day
7 you leave --
8 DR MEATES: I have not left, I am just no longer the lead on
9 the ward. I am still going to receive the results and
10 I will still pass them on.
11 MR GARNHAM: The obligation then is on you to ensure that
12 Rossiter or whoever else is taking on care of Victoria
13 gets them?
14 DR MEATES: If the photographs come to me it is my
15 obligation to pass them on.
16 MR GARNHAM: You do not, you say, get to see them.
17 DR MEATES: No. I did not see them. What do you mean I do
18 not get to see them?
19 MR GARNHAM: It was nothing clever in that expression. You
20 did not see them?
21 DR MEATES: I did not see them, no.
22 MR GARNHAM: So it is not surprising then that Dr Rossiter
23 does not get them either?
24 DR MEATES: I believe that they were in the notes. I am not
25 quite sure what happened but they have followed
102
1 a process that I would have expected them to follow in
2 terms of they were taken and they are then filed in the
3 notes. I would usually think that that would be used at
4 the case conference. How in between those two -- the
5 pathway between those two I am not clear about and
6 I cannot remember seeing them myself.
7 MR GARNHAM: Whatever the process is, neither of the
8 consultants concerned with this child's care get to see
9 these photographs.
10 DR MEATES: No, but we had both seen the child and the
11 photographs were just documentary evidence of what we
12 had already seen.
13 MR GARNHAM: You had not examined her.
14 DR MEATES: Well, I would differ with you. I had seen her
15 scalds.
16 MR GARNHAM: You had not seen the scars to her body.
17 DR MEATES: No I had not, but they had been documented and
18 I had seen the documentation of them and that was
19 available.
20 MR GARNHAM: You were just explaining that it did not matter
21 you did not see the photographs because you had examined
22 her, that is a complete non-sequitur since your
23 examination did not extend to her body.
24 DR MEATES: Not my personal examination, no, but the
25 documentation about her injuries that were shown in the
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1 photographs was all present in the notes.
2 MR GARNHAM: But are you saying it was not of use for you
3 the consultant to see these photographs, you having not
4 examined her?
5 DR MEATES: I am not saying it is not of use. I am saying
6 that the fact that I did not was not a major problem.
7 It was not going to add to my feelings about what was
8 happening with this child. It was really there to be
9 shared with other professionals in a multiagency meeting
10 and I believed that this child would have a case
11 conference and I believed these photographs would be
12 shared in that arena.
13 MR GARNHAM: But particularly in the case of a consultant
14 who has not seen the scars with her own eyes, the
15 photographs are an awful lot better than sketches on
16 a body map.
17 DR MEATES: Certainly if I was the consultant in charge of
18 the case that is correct but I do believe that --
19 MR GARNHAM: You were not, Rossiter was.
20 DR MEATES: I do believe Dr Rossiter had seen those marks.
21 MR GARNHAM: Yes, I see. 29th July was your last day on
22 the ward so you tell us you were not there for
23 Victoria's discharge.
24 DR MEATES: That is right.
25 MR GARNHAM: Who took on the job of admitting consultant, as
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1 it is called, for the second week?
2 DR MEATES: Dr Rossiter.
3 MR GARNHAM: Do you agree looking at the matter in the round
4 that it would have assisted social services and others
5 who had thereafter to assume the care of Victoria if
6 there had been a full accurate written report on
7 Victoria's condition?
8 DR MEATES: I would have expected that we would have been
9 asked for a report. I would have expected that at the
10 multiagency forum for sharing of information we would
11 have given that report and I would have expected it to
12 have included all the information that we had gathered,
13 both the information as it was documented, but also the
14 information that had been gathered verbally.
15 MR GARNHAM: What is the multiagency forum for sharing of
16 information?
17 DR MEATES: In this case I was expecting a case conference
18 but you were earlier talking about predischarge planning
19 meetings. That may also be a type of multiagency
20 sharing of information.
21 MR GARNHAM: Your point is that by one means or another
22 there should have been such a multidisciplinary meeting.
23 DR MEATES: My point is that we expected one. There should
24 have been one and we expected that there would be one
25 and so all the time that this was going on it was on the
105
1 understanding that there would be one.
2 MR GARNHAM: It is for doctors, is it not, to call
3 predischarge meetings, multidisciplinary meetings?
4 DR MEATES: Well in this case I was expecting a case
5 conference which I would have thought a more appropriate
6 meeting before a predischarge planning meeting.
7 MR GARNHAM: Yes, but in the absence of that doctors are
8 able to call a predischarge conference?
9 DR MEATES: Doctors are able to, yes.
10 MR GARNHAM: And given that it had been your intent and
11 understanding that there should have been this sharing
12 of information, absent a case conference, that was
13 essential?
14 DR MEATES: Well I was not aware that the case conference
15 was not going to occur and I do not think any of us were
16 before she was discharged.
17 MR GARNHAM: Of course, I understand that is what you say
18 but at the moment of discharge it was readily apparent
19 to those who had Victoria's care that there had not been
20 a case conference because they had not been at it.
21 DR MEATES: At the time of discharge, yes.
22 MR GARNHAM: So therefore they could have called
23 a predischarge meeting before she left.
24 DR MEATES: Well, I do not think that any of the doctors
25 were aware before she left that she was going without --
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1 I mean I think when she left it was not on
2 Dr Rossiter's -- with Dr Rossiter's agreement and
3 Dr Rossiter was not aware that she was going to be
4 discharged in this way and never in the past have we had
5 a situation where a social worker would have phoned and
6 asked for a child to be discharged without them having
7 first either discussed it in a multiagency meeting or
8 discussed it with the consultant themselves.
9 MR GARNHAM: But that demonstrates a clear breach of
10 sensible procedures, does it not, by the hospital, that
11 they allow that to happen?
12 DR MEATES: Well I do not know that we allowed it to happen.
13 It happened.
14 MR GARNHAM: What do you mean? She was escorted out
15 contrary to your consent.
16 DR MEATES: Well I do not think that she had the consent.
17 If someone had asked me I would not have given my
18 consent. I think Dr Rossiter if she had been asked
19 would not have given her consent. It occurred without
20 that consent and the way it occurred was in a way that
21 a nurse may not be aware that the multiagency meeting
22 had not occurred. Dr Rossiter would have been but the
23 nurse who was contacted may not have been.
24 MR GARNHAM: But then the nurse should not have allowed
25 Victoria to go, should she?
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1 DR MEATES: Certainly after this we changed the procedures
2 so this could not happen, but prior to this time there
3 had been situations where children had been under child
4 protection investigation, where there had been case
5 conferences, the child had been registered, plans were
6 made around the discharge but they were then -- we were
7 then waiting for those arrangements to be finalised and
8 so that the discharge plan was made conditional upon the
9 social workers phoning to say that whatever they had
10 arranged had occurred. So it was not absolutely unusual
11 for a nurse to get a call from a social worker to say
12 "things are in place." It is just she did not
13 understand or was not aware that that had not been fully
14 discussed already with Dr Rossiter. That is what was
15 unusual.
16 MR GARNHAM: And that was a breakdown in communication then
17 inside the hospital?
18 DR MEATES: No, I do not think there was a breakdown in
19 communication within the hospital. I think that the
20 hospital were expecting a case conference and we were
21 waiting to be invited to that and we were not expecting
22 for Victoria to go home prior to that meeting, and at
23 that meeting there would have been a full report of all
24 of the things that we had observed during her hospital
25 stay, and it would have included everything that was
108
1 documented, but it included also a lot that was not
2 documented.
3 MR GARNHAM: I am sorry, I just find that an extraordinary
4 explanation. Help me with it a little more. The child
5 is in the hospital.
6 DR MEATES: Yes.
7 MR GARNHAM: She is under the care of doctors. Doctors are
8 entitled to say "yes" or "no" to whether she leaves?
9 DR MEATES: We had asked for a child protection
10 investigation.
11 MR GARNHAM: Just "yes" or "no".
12 DR MEATES: I think it is misleading. You seem to be
13 confused and I would like to try and clarify that.
14 MR GARNHAM: All right.
15 DR MEATES: We had asked for a child protection
16 investigation. It would have been my expectation that
17 nobody would have said "yes" or "no" before
18 a multiagency meeting and the sharing of the information
19 that people had been asked to gather. So I would not
20 have even expected a doctor to say she could go without
21 there having been a case conference in this particular
22 case.
23 MR GARNHAM: But doctors or nurses could have prevented her
24 leaving.
25 DR MEATES: If they were aware that there had been no case
109
1 conference and they were aware of the unusual way that
2 she was being discharged, I am sure that they would
3 have.
4 MR GARNHAM: So the answer to my question is yes they could
5 have?
6 DR MEATES: They could have if they were aware of those
7 things.
8 MR GARNHAM: And they should have been aware there was no
9 case conference because they should have been
10 collectively or representatively at it?
11 DR MEATES: No. The doctors who would have been around at
12 the time she was discharged would have been junior
13 doctors and it would not have been my expectation that
14 they would have been the doctors who would have been
15 present at the case conference.
16 MR GARNHAM: They check, do they not? They look in the
17 notes, they do not let anybody walk out with a child
18 like Victoria?
19 DR MEATES: Sorry, they check what is in the notes?
20 MR GARNHAM: That there has been a case conference.
21 DR MEATES: There was nothing in the notes to suggest there
22 had been.
23 MR GARNHAM: Quite.
24 DR MEATES: But what was not clear was that the decision to
25 discharge her had not been discussed with Dr Rossiter
110
1 and certainly I agree that that was not an ideal
2 situation. It is just that it had never occurred before
3 and it was very hard to imagine it occurring. As soon
4 as it did occur we changed the system so that from the
5 next week no child could have left in that way without
6 the consultant having been called.
7 MR GARNHAM: Dr Rossiter says in a letter to Petra Kitchman
8 after this has happened words to the effect: "It appears
9 that ward staff believe that social workers can
10 discharge patients." She told us that that appeared to
11 be their belief and that it was plainly wrong. Do you
12 disagree with that?
13 DR MEATES: I disagree that social workers should discharge
14 patients but I do not disagree that sometimes
15 a consultant may have a discharge plan that is
16 conditional upon the social workers doing what they need
17 to do.
18 MR GARNHAM: Be that as it may, does it not remain the case
19 that at the time of discharge or if necessary
20 immediately afterwards, it would have been sensible and
21 prudent for the doctors to have provided social workers
22 with a comprehensive medical report on Victoria's
23 condition and the causes of her signs and symptoms?
24 DR MEATES: Yes.
25 MR GARNHAM: You say in paragraph 12 of your statement that
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1 your impression of this case was that everything was in
2 hand and everything remained on course.
3 DR MEATES: Yes.
4 MR GARNHAM: Do you remain of that view?
5 DR MEATES: Yes, and I was -- certainly the information that
6 was coming to me made me believe that. Certainly the
7 memo I got from Karen Johns on the 29th that said that
8 she had passed the case over to Haringey Social
9 Services, she talked about the police being involved,
10 all of that reinforced to me that what we were getting
11 was a full child protection investigation that would
12 culminate in a case conference.
13 MR GARNHAM: And you remain of that view despite firstly
14 that there had been no full medical examination of
15 Victoria, everything on course, everything done as it
16 should?
17 DR MEATES: What, you are asking me that now with the
18 benefit of that information?
19 MR GARNHAM: Yes.
20 DR MEATES: In fact what needed to be done with Victoria was
21 still on course. The examination could still have
22 occurred, but yes, everything was I believe on course.
23 We believed that there would be a child protection
24 conference at the end of the child protection
25 investigation.
112
1 MR GARNHAM: Despite the fact that there had been no proper
2 liaison with social workers?
3 DR MEATES: I disagree with that. I think that if we go
4 back to the memos that you brought me to before from
5 Karen Johns, I think they are in a different volume.
6 MR GARNHAM: They are, we know which ones you mean.
7 DR MEATES: Could I see them though?
8 MR GARNHAM: Yes, 37/050 I think.
9 DR MEATES: I think it was volume 5.
10 MR GARNHAM: Volume 5/262, thank you.
11 DR MEATES: As I said to you, I do not recall seeing the 267
12 one but it may well be that during the ward discussions
13 that it was discussed by the nurses, the contents of
14 that, but certainly if you go from this particular memo
15 where Karen is saying she needs further information, it
16 needs to be discussed with the family, and then to the
17 memo of the 29th, where she is saying that she has now
18 passed it over to Haringey Social Services, then that
19 reinforces to me that everything that she had asked for
20 in the first memo has now occurred and that -- so yes,
21 I think that everything is on course. That is what
22 I believed was the case.
23 MR GARNHAM: Does not the fact that she was discharged in
24 the circumstances in which you have described and which
25 you regard as unsatisfactory demonstrate that there had
113
1 not been adequate liaison between you and social
2 workers?
3 DR MEATES: But we were not aware that that was the case.
4 We were waiting for the case conference.
5 MR GARNHAM: That is not my question.
6 DR MEATES: In retrospect, yes.
7 MR GARNHAM: Let me ask the question. In retrospect is it
8 not apparent that there was not adequate liaison between
9 you and social workers?
10 DR MEATES: In retrospect yes, but I think that we tried to
11 do everything that we could have and if we had been
12 asked to a case conference I have no doubt that we would
13 have been able to communicate and there would have been
14 no communication. I think the problem was that we were
15 never asked for that formal report.
16 MR GARNHAM: Everything on course despite the fact that
17 Victoria had never been interviewed, spoken to through
18 a translator?
19 DR MEATES: I am not saying that everything had been done in
20 that week. What I am saying is that there was no reason
21 to believe that the child protection investigation and
22 everything that goes with it, that includes an interview
23 with the mother and the other carers, or Miss Kouao and
24 other carers, and interview with the child if that is
25 deemed appropriate, I believe that that is part of the
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1 child protection investigation. I am not saying it had
2 all occurred. What I am saying is there was no reason
3 for me to believe that that was not on course to occur.
4 MR GARNHAM: But Victoria was discharged without it having
5 occurred and she was a child who as you well knew had
6 got belt buckle marks on her, so she was discharged back
7 to the woman who had had her in her care.
8 DR MEATES: She was not discharged by the consultant and it
9 was an unusual discharge and we were not happy with
10 that.
11 MR GARNHAM: But it is what happened.
12 DR MEATES: Yes.
13 MR GARNHAM: And you still remain --
14 DR MEATES: As I said to you, since it happened and we
15 realised that it might happen we changed the procedures
16 so that could not happen again.
17 MR GARNHAM: That is a little late in Victoria's case.
18 DR MEATES: We had no way of knowing this was going to
19 occur. It had never occurred in the past and there was
20 no way I would have imagined it would have occurred. It
21 did.
22 MR GARNHAM: Despite the fact that there was no interview
23 with Kouao properly recorded in the notes. Still
24 everything on course, is it?
25 DR MEATES: In my previous experience with child protection
115
1 cases, the major interview with the carer occurs with
2 the police and as part of their investigation so it
3 would have been inappropriate for us to be doing other
4 interviews with her in the midst of that and there was
5 no reason for me to believe that she would not be
6 interviewed by the police.
7 MR GARNHAM: Everything in hand despite the fact that
8 neither the consultant nor the social services get the
9 photographs.
10 DR MEATES: I would not have expected to have the
11 photographs at the end of that week.
12 MR GARNHAM: At all?
13 DR MEATES: The photographs are available.
14 MR GARNHAM: But they are never sent to the police or
15 obtained by police or social services or by the two
16 consultants.
17 DR MEATES: The police did not ask for them and neither do
18 social services, but the place that they would have been
19 shared is the case conference and when the case
20 conference was called the photographs would have formed
21 part of the medical evidence that was produced at that
22 time.
23 MR GARNHAM: Everything on course despite the fact that you
24 at least did not contact the liaison health visitor.
25 DR MEATES: Sorry, I am not sure where that came from but in
116
1 what -- for what reason?
2 MR GARNHAM: You did not ensure that the liaison health
3 visitor was aware of what was going to happen to
4 Victoria, that she was going to be discharged back into
5 the community.
6 DR MEATES: I was not there on the week that she was
7 discharged but certainly we had liaison health visitors
8 who came to our psychosocial meeting so I would have
9 expected that discussions would have occurred with the
10 liaison health visitors that were available to us during
11 that week, and in terms of the further liaison with
12 health visitors, in terms of child protection I would
13 normally leave that to Dr Rossiter.
14 MR GARNHAM: Yes. Thank you very much.
15 THE CHAIRMAN: Thank you. Mr Mason please.
16 MR MASON: Good morning Dr Meates.
17 DR MEATES: Good morning.
18 MR MASON: We have heard a lot about the rota system.
19 I want to ask you I hope two simple questions about it.
20 Firstly, did it work for staff?
21 DR MEATES: Yes.
22 MR MASON: A rather more important question: did it work for
23 patient care?
24 DR MEATES: Yes.
25 MR MASON: Paragraph 12 you were asked about and your
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1 impression that everything in the case was in hand and
2 on course. Is that reference in your statement to the
3 position as you saw it at the end of your week on duty?
4 DR MEATES: Yes.
5 MR MASON: And it was not commenting on what may or may not
6 have happened later?
7 DR MEATES: No, I do not think that -- in retrospect of
8 course it makes things much easier but that was my
9 position at the end of my week.
10 MR MASON: Indeed after the end of that week did you have
11 any sort of responsibility for Victoria whatsoever?
12 DR MEATES: No.
13 MR MASON: You were asked about whether you should have
14 reviewed the photographs. In your view would there have
15 been any clinical or child protection purposes in your
16 reviewing the photographs personally?
17 DR MEATES: No.
18 MR MASON: In your memorandum or handwritten memorandum back
19 to Karen Johns, I hope I need not take you to it,
20 05/262, you referred to the police obtaining the
21 photographs through the procedures which they would know
22 about. What procedures are you talking about there?
23 DR MEATES: I think there are two ways they could have got
24 them. Either through the child protection procedures,
25 so at the child protection conference, and then through
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1 Dr Rossiter or alternatively by requesting them through
2 the hospital external relations department, and if they
3 do that then the consultant would have been asked for
4 consent, which is why I have annotated my consent as
5 given so if they did ask for them in that way it would
6 facilitate it without it having to come back to me.
7 MR MASON: I gather from that that photographs are given on
8 request, assuming that it is felt the request is
9 appropriate but they are not handed out without a formal
10 request. Is that correct?
11 DR MEATES: I would not have seen it as my remit to
12 distribute photographs.
13 MR MASON: Can I turn to one or two slightly wider matters?
14 I understand from your c.v, volume 6, page 177, that you
15 have a training role for the Royal College of
16 Paediatrics and Child Health in the northeast Thames
17 area, is that correct?
18 DR MEATES: Yes.
19 MR MASON: Does that mean you are familiar with standards in
20 other hospitals in the region, firstly in relation to --
21 is this in relation to training for junior doctors?
22 DR MEATES: It is in relation to training for junior
23 doctors.
24 MR MASON: Within that context are you familiar with
25 standards and practices of training of junior doctors in
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1 child protection matters?
2 DR MEATES: Yes.
3 MR MASON: Does the same go for Child Protection Guidelines?
4 DR MEATES: Yes.
5 MR MASON: And does it also go for standard of note-keeping?
6 DR MEATES: Yes.
7 MR MASON: May I take those three in turn and how does North
8 Middlesex or how did North Middlesex compare in relation
9 to the other hospitals you knew about in relation to
10 training of junior doctors and child protection?
11 DR MEATES: I think it is good, above average.
12 MR MASON: How did the procedures and guidelines compare?
13 DR MEATES: I think they are good but I think that they
14 would -- an average/good.
15 MR MASON: And in terms of note-keeping by the standards of
16 1999, general, not talking about Victoria's case, I will
17 come on to that, but the general standard of
18 note-keeping, how did that compare with other hospitals
19 in 1999?
20 DR MEATES: Average. We did have a structured admission
21 sheet which I think perhaps lifted our notes a little
22 bit above the average but a lot of other paediatric
23 departments have structured notes, so they will be
24 average with those.
25 MR MASON: We have heard if you have structured notes you
120
1 have to complete them, and you have mentioned some of
2 the shortcomings, and you may not be aware but the Trust
3 has formally accepted right from the very start of the
4 Inquiry that the note-keeping was not adequate.
5 DR MEATES: I do accept the note-keeping was inadequate.
6 MR MASON: Can I ask you by 1999 standards within the
7 Paediatric Department where the standard note-keeping in
8 Victoria's case came within the spectrum, good, bad,
9 average or what?
10 DR MEATES: Having looked much more closely at the admission
11 note, her admission was below average. The daily
12 records I would say would be average for that time.
13 MR MASON: And have any steps been taken to improve the
14 standard of note-keeping that you are aware of?
15 DR MEATES: We constantly go through the notes and the
16 keeping of the notes on the ward round and an
17 apprenticeship type of way, but this year I have written
18 a guideline on keeping progress notes for the
19 department.
20 MR MASON: I am not sure that the Inquiry has that document.
21 Dr Meates, do you have a copy on you?
22 DR MEATES: I do.
23 MR MASON: I wonder if that could be produced. I do not
24 know if you need to see it now. Is that a copy the
25 Inquiry can keep?
121
1 DR MEATES: Yes.
2 MR MASON: Was it your practice to attend psychosocial
3 meetings from time to time?
4 DR MEATES: Yes, I usually attend on my week on the wards as
5 admitting consultant and at other times when I have
6 specific concerns.
7 MR MASON: I would like to take you to the minutes of
8 a meeting that you were not at because we note your
9 apologies, volume 26B, page 235. Minutes of a meeting
10 between paediatric social workers and consultant
11 paediatricians held on 17th December 1997. This is
12 minutes of a meeting talking about Monday ward meetings,
13 is that the same thing as psychosocial?
14 DR MEATES: Yes.
15 MR MASON: I want to ask you about a couple of points there.
16 Firstly, the first paragraph, the second half of that
17 paragraph:
18 "It was agreed that everybody must be willing to
19 realise the different roles people play in the team and
20 that there should be mutual respect".
21 I know that was not your view at the meeting because
22 you were not there, but would that have been your view
23 if you were at the meeting?
24 DR MEATES: I think it is absolutely essential for
25 multidisciplinary working, so yes.
122
1 MR MASON: "It was felt in respect of the Monday meetings
2 that a clearer structure and clear concise details of
3 each case and patient should be presented
4 systematically."
5 Would you agree with that sentiment?
6 DR MEATES: Yes.
7 MR MASON: Was anything done after this meeting to help that
8 happen?
9 DR MEATES: Certainly the meetings run better now and
10 I guess would be -- definitely can be described as more
11 systematic.
12 MR MASON: And are the details of each patient presented in
13 a systematic way?
14 DR MEATES: Yes.
15 MR MASON: And the last point, would you have shared the
16 view of the consultants present that the absence of
17 social workers from those Monday meetings made matters
18 worse and communication more difficult?
19 DR MEATES: It makes it very difficult.
20 MR MASON: I just want to ask you about discharge
21 procedures. You have already mentioned talking about
22 implicit and explicit consent by a consultant for
23 discharge of a child about whom they have protection
24 concerns, and you said that the procedures were changed
25 the week after Victoria's discharge. Is that correct?
123
1 DR MEATES: Yes, Dr Rossiter was quite upset once she knew
2 Victoria had been discharged and it was discussed at our
3 departmental meeting where senior members of the team
4 meet and following that -- I do not know if you have
5 a copy and I am not sure where it is but there was
6 a guidance to ward staff and the junior doctors that
7 a social worker could not phone up and discharge
8 a patient, that it must be discussed further with the
9 consultant, and I believe that they were in place
10 shortly after that and in fact cases that may have --
11 I think Dr Rossiter alludes to a couple of cases where
12 if those procedures were not in place the same thing may
13 have happened but it was avoided.
14 MR MASON: I asked Dr Rossiter about this point at the end
15 of a somewhat gruelling two half days and she said that
16 this process by way of only a consultant could make the
17 final discharge decision was not changed until much
18 later. Do you think she was wrong about that?
19 DR MEATES: I think she was mistaken about that. It was
20 changed the week after Victoria was discharged. What
21 was changed this year with the new Chief Executive was
22 the amendments to the Child Protection Guidelines.
23 MR MASON: Do you think there may have been a written
24 document produced shortly after Victoria's discharge?
25 DR MEATES: I am pretty certain there was a written document
124
1 but I do not know where it is.
2 MR MASON: Before Mr Garnham asks me, can I ask you if you
3 might be able to find a copy?
4 DR MEATES: Well --
5 MR MASON: Not now.
6 DR MEATES: Right, I see. Certainly I will look and if I do
7 I will pass it to you.
8 MR MASON: I am also looking at Mrs Diss who I am sure will
9 help.
10 Thank you, I have no more questions.
11 THE CHAIRMAN: Thank you. Dr Meates that is a very
12 important piece of information that you have just been
13 talking about with your advocate.
14 MR GARNHAM: We already have it sir.
15 THE CHAIRMAN: Right. Dr Meates, take it as read that
16 a consultant cannot be on duty 24 hours a day, seven
17 days a week, 365 days a year, so there is bound to be
18 some kind of arrangement of the kind that you were
19 trying to explain at the beginning of your evidence.
20 Forget the nomenclature that was used. What I am
21 interested in is what you saw as your personal
22 responsibilities when you came on duty when Victoria was
23 on the ward.
24 DR MEATES: Well I was aware that Victoria, there were child
25 protection issues and that she had already been seen by
125
1 Dr Rossiter who I believed would take the lead and that
2 was agreed. So I saw my responsibilities as making sure
3 that the day-to-day management occurred appropriately.
4 Any new problems were dealt with, that sort of thing.
5 THE CHAIRMAN: So it was a fairly -- I cannot think of
6 a better word -- superficial responsibility.
7 DR MEATES: In one way, yes.
8 THE CHAIRMAN: I think I understood you right, correct me if
9 I am wrong, you did not read the case notes?
10 DR MEATES: I did not read the case notes on that ward round
11 or during her hospital stay. I think I saw parts of
12 them. I do recall seeing the diagrams.
13 THE CHAIRMAN: Yes. But you did not, you clearly did not
14 behave at any rate in a way which I think we have agreed
15 would lead me to believe that you saw yourself as having
16 a key responsibility for the welfare of Victoria.
17 DR MEATES: No, not a key responsibility.
18 THE CHAIRMAN: And I imagine, because you have got a lot of
19 experience, that you would accept from me that one of
20 the key issues or one of the key responsibilities that
21 all professionals have in child protection is to record
22 very carefully their observations?
23 DR MEATES: Yes.
24 THE CHAIRMAN: And one of the responsibilities that
25 everybody on the ward has is to make sure those
126
1 recordings are accurate and up-to-date?
2 DR MEATES: Yes.
3 THE CHAIRMAN: What do you think of the part that you played
4 in this?
5 DR MEATES: Well, I did not check what was written. I knew
6 what was being said. I did expect that what was being
7 said would be brought together in a final report but
8 I agree with you the notes were not up to standard and
9 there was a lot of room for improvement.
10 THE CHAIRMAN: You said earlier on in the ward round that
11 you did not read the notes, that you relied upon the
12 nurses to tell you what they knew and what their
13 concerns were.
14 DR MEATES: In this particular case, yes, because there was
15 a lot of discussion about Victoria because she had been
16 in for a few days and there had been a lot happening and
17 there had been psychosocial rounds so there was a lot of
18 discussion and so the notes were not going to add to
19 that. Obviously in some cases the notes are the main
20 information you have about a child and I would have
21 concentrated more on those in some cases.
22 THE CHAIRMAN: But as the most senior doctor, it is of
23 course important to listen to what the nurses and other
24 people may want to bring to you, but was it not your
25 responsibility to form your own clinical judgment?
127
1 DR MEATES: I did form my own clinical judgment but I do not
2 think it was my responsibility to go and relook at
3 everything that had been -- you mean re-examine her
4 completely? I would not have seen that that would be
5 appropriate for me to do at that time, unless it had
6 been asked of me by Dr Rossiter or it had been discussed
7 in another forum that that should happen.
8 THE CHAIRMAN: You formed your clinical judgment on the
9 basis of what other people told you.
10 DR MEATES: No, I formed my clinical judgment on the basis
11 of what I saw in terms of the scalds and on -- yes, and
12 on the information other people had given me but that
13 was available to me and that is a part of the
14 information I have to be able to make decisions. It
15 was, a lot of it was objective type of information. It
16 was not just opinions that I was basing my information
17 on, it was objective things, the time of the injury, the
18 time she attended, what people had seen her do rather
19 than how people had interpreted why she was doing what
20 she was doing.
21 THE CHAIRMAN: So I understand your position, are you saying
22 to me that you believe that what you did, when you did
23 it and how you did it was good practice?
24 DR MEATES: I did believe that, yes, because I thought that
25 we had asked for a child protection conference. In my
128
1 past experience things were moving as they had in the
2 past where there had been a child protection conference
3 at the end, so yes I thought that and I thought that the
4 right -- good practice in this case was to get her
5 discussed in a multiagency meeting like a child
6 protection conference, and my expectation probably was
7 that she would be registered on the Child Protection
8 Register. In terms of that, yes, I thought that was
9 going along.
10 THE CHAIRMAN: Looking back, do you still believe it was
11 good practice?
12 DR MEATES: It is hard to know where it would not be good
13 practice because where it fell away it is very hard for
14 me to have taken responsibility for that, if you see
15 what I mean. I can take responsibility for the fact
16 that the notes were not up-to-date and as the consultant
17 on I should have been able to -- that is my
18 responsibility. But I think that where the practice
19 falls away from good practice is in the fact that there
20 was no case conference and no sharing of the information
21 that had been gathered and I cannot take responsibility
22 for that.
23 THE CHAIRMAN: So apart from the note-keeping you do not
24 believe that there was anything else in your practice
25 that you think could have been improved upon?
129
1 DR MEATES: Well as I have said there were guidelines that
2 we had not even thought about because it had never
3 happened, you know to cover the contingency of her being
4 discharged, so I am not saying there was nothing that
5 could be improved on but what I am saying is that
6 whether you call that poor practice or, you know,
7 sometimes you just do not know that something is going
8 to happen and you cannot predict it and it is not until
9 it has happened that you realise that you need to put
10 something in place to stop that happening again.
11 THE CHAIRMAN: Yes, I mean I would have thought that the
12 inappropriate discharge of a patient from a hospital in
13 these circumstances was actually a fairly elementary
14 thing, not something that required a great deal of
15 thought.
16 DR MEATES: Sorry?
17 THE CHAIRMAN: I probably did not express that well. What
18 I am putting to you is that when it comes to good
19 practice I would have thought the arrangements for
20 discharge of a child that was admitted because of child
21 protection suspicions was a fairly straightforward
22 thing.
23 DR MEATES: It is straightforward and certainly there were
24 procedures in place but they did not specifically say
25 that if a social worker phoned, check with the
130
1 consultant, and in the past we had never had a situation
2 where a social worker had phoned without that having
3 happened, but we had had cases where social workers had
4 phoned appropriately, so what I am saying is that we had
5 considered the possibility but we just -- that a social
6 worker might phone. We just had not considered the
7 possibility that they would do so without discussing it
8 first with the consultant or in a case conference.
9 THE CHAIRMAN: All right then, leaving aside the discharge,
10 just thinking about the treatment, you said in answer to
11 Mr Mason that the arrangements that operated in the ward
12 at the time worked for the staff and worked for the
13 patients. Do you think it worked for Victoria?
14 DR MEATES: These questions are awkward and I will tell you
15 why they are awkward because in retrospect clearly what
16 happened for Victoria was not right but if you are
17 asking me did I think that the way the clinicians work
18 acted against her, no I do not think it did.
19 THE CHAIRMAN: That is your considered opinion?
20 DR MEATES: I think it is the opinion of the department
21 because if we felt that the way we worked had led to
22 this critical incident then we would have altered the
23 way we worked. So it is not just my considered opinion.
24 I think it is a departmental opinion.
25 THE CHAIRMAN: But I am asking you if that is your
131
1 considered opinion.
2 DR MEATES: Yes, it is.
3 THE CHAIRMAN: Having had the apparent shock of Victoria
4 being discharged, would it have been possible to have
5 asked for a post-discharge case conference?
6 DR MEATES: I am sure it could have been, yes.
7 THE CHAIRMAN: Why do you think that did not happen?
8 DR MEATES: I cannot tell you that, I do not know.
9 MR GARNHAM: No further questions from me thank you.
10 MR MASON: Just one very small point. I am not quite sure
11 if Dr Meates and yourself are talking about quite the
12 same thing about the system, because you refer to
13 something I had asked her about which is the rota
14 system, which is a very -- and I thought she was
15 answering in terms of the rota.
16 DR MEATES: Yes, I was.
17 MR MASON: Did the rota system work. If you were thinking
18 in a wider or different context it may be that the
19 Doctor will want to say something about that, I do not
20 know.
21 THE CHAIRMAN: You can say what you wish Dr Meates.
22 DR MEATES: I did think that you were specifically asking
23 about the way we covered the ward. Were you asking
24 about something else?
25 THE CHAIRMAN: No, I was asking about covering the ward for
132
1 reasons that I think you might understand.
2 DR MEATES: No, we have not changed the way we work on the
3 ward.
4 MR GARNHAM: Thank you very much Dr Meates.
5 Sir our next and final witness for today is
6 Dr Alexander and we are reasonably confident that his
7 evidence can be taken before we break for lunch.
8 I understand however that Mr Mason needs five minutes
9 with Dr Alexander before he is called because there was
10 some delay in his arriving, the details of which we
11 probably need not trouble you with.
12 MR MASON: Dr Alexander was cancelled yesterday and did not
13 arrive until this morning. Five minutes will do me.
14 I do not want to interrupt the Inquiry's timetable.
15 THE CHAIRMAN: I understand that there was
16 a misunderstanding which of course we must accept
17 responsibility for, and we will arrange to adjourn for
18 five minutes now. Can I take the opportunity to say
19 that my colleague Mr Richardson will have to leave at
20 five minutes to one and I have agreed that he will
21 depart at five minutes to one, and Mr~Richardson being
22 a doctor, I think that is not detrimental to the
23 Inquiry. So five minutes ladies and gentlemen.
24 (A short break)
25 MR SHELDON: Dr Alexander please.
133
1 DR SAJI DANIEL ALEXANDER (sworn)
2 MR SHELDON: Could you confirm your full name and
3 professional address.
4 DR ALEXANDER: Saji Daniel Alexander, currently working at
5 the Chelsea and Westminster Hospital.
6 MR SHELDON: You have moved from Southend?
7 DR ALEXANDER: I have.
8 MR SHELDON: You have prepared a statement for use in this
9 Inquiry, a copy is on its way to you now. When it
10 arrives could you have a look at the last page please.
11 Is that your signature?
12 DR ALEXANDER: It is.
13 MR SHELDON: Are you happy that the facts and matters in
14 that statement are true?
15 DR ALEXANDER: Yes.
16 MR SHELDON: Volume 6 page 8.501 sir. Dr Alexander you
17 qualified as a doctor in India.
18 DR ALEXANDER: That is right.
19 MR SHELDON: You have worked in paediatrics in a number of
20 UK hospitals since 1995.
21 DR ALEXANDER: I did.
22 MR SHELDON: You are currently based now at Chelsea and
23 Westminster Hospital, but between March and September
24 1999 you were a locum paediatric registrar at the NMH.
25 DR ALEXANDER: I was.
134
1 MR SHELDON: When you were at the NMH as I understand it you
2 divided your time equally between the special care baby
3 unit and the paediatric day assessment unit; is that
4 correct?
5 DR ALEXANDER: That is correct.
6 MR SHELDON: But you would sometimes cover Rainbow Ward when
7 you were on-call?
8 DR ALEXANDER: I would.
9 MR SHELDON: How often would you find you are yourself on
10 the ward?
11 DR ALEXANDER: If I was on-call I would be covering the
12 Rainbow Ward only from 5 pm to 8.30 am. But there
13 were -- there would have been occasions where the
14 registrar who was meant to cover Rainbow Ward would
15 either be on annual leave or off for some other reason,
16 I would be called in to cover Rainbow Ward.
17 MR SHELDON: I see. So we know for example from your
18 statement that you were on on 27th July and then
19 3rd August. Was the regular pattern that you would be
20 on-call once a week?
21 DR ALEXANDER: Not necessarily. You might be twice a week
22 or -- I was making the rota at that time.
23 MR SHELDON: It varied?
24 DR ALEXANDER: Yes.
25 MR SHELDON: You say in your statement you were aware of the
135
1 Trust's child protection guidelines.
2 DR ALEXANDER: I was.
3 MR SHELDON: Volume 39, page 221, I wonder if a copy could
4 be put in front of you. Were you taken through these
5 guidelines when you arrived at the NMH or were you just
6 left to your own devices to familiarise yourself with
7 them?
8 DR ALEXANDER: I have not had a formal induction programme
9 but I was taken through most of the protocols and taken
10 through the Child Protection Guidelines at the NMH.
11 MR SHELDON: I see. Could I take you to one page in
12 particular, which is page 279 in that volume. That is
13 a page headed "Referral to Social Work Department" and
14 you can see there underneath the first block of bold
15 writing the following statement:
16 "In order to address these questions the social
17 worker needs as much information as possible".
18 Then a list of the information that should be
19 included in a referral. Were you aware of the
20 requirements imposed by that particular section of the
21 guidelines whilst you were working on the ward?
22 DR ALEXANDER: Yes. I mean I cannot clearly specifically
23 remember but these are quite standard procedures or
24 standard information one would expect to give.
25 MR SHELDON: It underlines, does it not, as those standard
136
1 procedures may commonly do, that it is vital that the
2 social worker is given as full a picture of possible
3 problems faced by a child who is suspected of having
4 been abused as possible?
5 DR ALEXANDER: That is right.
6 MR SHELDON: Turning to your involvement with Victoria you
7 say in your statement that you cannot be sure of your
8 first involvement, although the first record of your
9 involvement is the 27th July 1999. Is that right?
10 DR ALEXANDER: That is correct.
11 MR SHELDON: Can you still not recall any details of her
12 admission other than what is in the notes?
13 DR ALEXANDER: No, I cannot.
14 MR SHELDON: Have you attempted to check and see whether you
15 were on-call on Rainbow Ward prior to the 27th July but
16 after the 24th when she was admitted?
17 DR ALEXANDER: There would be actually no way of knowing
18 that because you either -- there were only one set of
19 notes I made, that is for the night on-call registrar,
20 and the daytime was like you said earlier, I either
21 covered special baby care unit for three months and
22 assessment for the other three months, Dr Richardson
23 covered the ward and there was another person for
24 special care, so you would not have a rota for that.
25 MR SHELDON: We will simply never know.
137
1 DR ALEXANDER: No.
2 MR SHELDON: We do know you were there on the 27th because
3 we have a note written by you in volume 37, page 262.
4 I wonder if you could be shown that. Last note on that
5 page, is that your handwriting?
6 DR ALEXANDER: You mean the signature? The last note, yes.
7 MR SHELDON: The last note dated 27.7, "WR Meates", and then
8 what follows, is that all you?
9 DR ALEXANDER: That is mine.
10 MR SHELDON: That is a record of a ward round you did with
11 Dr Meates on 27th July, both of you together.
12 DR ALEXANDER: That is correct.
13 MR SHELDON: Were you aware when you arrived at Victoria's
14 bed on that occasion that hers was a case of suspected
15 child abuse?
16 DR ALEXANDER: Yes, I was.
17 MR SHELDON: Were you aware that her admission had been
18 partly because it was suspected that she had been
19 abused?
20 DR ALEXANDER: Yes, in a sense because the immediate medical
21 reason for her admission was to treat the burns but
22 there was a strong suspicion that these burns could not
23 be fully explained.
24 MR SHELDON: How did you become aware of that information?
25 DR ALEXANDER: In Victoria's case I can no longer be sure
138
1 but I am sure we would have discussed it formally or
2 informally between registrars or at doctors meetings,
3 and I had not attended the psychosocial meeting but
4 I would have been aware of it.
5 MR SHELDON: So you would have become aware of it by some
6 mechanism prior to your arrival on the ward that day,
7 would you?
8 DR ALEXANDER: That is correct. I was aware that there was
9 a child called Victoria then known as Anna who was on
10 the ward.
11 MR SHELDON: So the situation was when you arrived at the
12 ward, it was, "Ah, this is the child Anna about whom
13 I have heard and about whom there are suspicions of
14 child abuse?"
15 DR ALEXANDER: That is right.
16 MR SHELDON: You cannot remember what you heard about her
17 specific case prior to arriving on the ward that day, is
18 that right?
19 DR ALEXANDER: No, I cannot.
20 MR SHELDON: When you got there do you remember whether or
21 not you had a look at the critical incident log?
22 DR ALEXANDER: I cannot remember but I think in normal
23 circumstances probably I did not.
24 MR SHELDON: It is certainly true that Dr Meates says she
25 did not on that occasion, but you have no recollection
139
1 of going and digging it out yourself?
2 DR ALEXANDER: No, but what usually happens is that any
3 critical incident in the past 24 hours or significant
4 critical incidents would be conveyed through the
5 accompanying team members.
6 MR SHELDON: I see and that would include nurses who had had
7 care of Victoria up until that point?
8 DR ALEXANDER: That is right.
9 MR SHELDON: And you indicate in paragraph 7 of your
10 statement that you think it was through those nurses
11 that you heard about a visit from Kouao to Victoria?
12 DR ALEXANDER: That is right.
13 MR SHELDON: But it is unlikely you would have been able to
14 get that information from anywhere else, is it not? It
15 would almost certainly have had to come from the nurses
16 if you had not read the critical incident log where it
17 is recorded?
18 DR ALEXANDER: Having looked at the notes carefully since,
19 if you look at the top of the page it does mention that
20 Dr Reynders has taken the consent for a skeletal survey
21 and photographs.
22 MR SHELDON: Yes. So you may have got it from the notes but
23 you may have got it from the nurses.
24 DR ALEXANDER: That is right.
25 MR SHELDON: The point I am trying to get at is that you
140
1 definitely spoke to the nurses on this occasion.
2 DR ALEXANDER: Yes, definitely.
3 MR SHELDON: Did the nurses say to you as far as you can
4 recall anything about suspicious marks they had found on
5 Victoria's body apart from the burns to her face?
6 DR ALEXANDER: I cannot remember.
7 MR SHELDON: Do you recall whether they asked you, or
8 Dr Meates who was with you, to have a look at marks on
9 Victoria's body that they were concerned about?
10 DR ALEXANDER: I cannot recall but probably now I know that
11 it has been recorded the day before so there might have
12 been a mention about it, that the body map has been done
13 and there are other injuries or old injuries to
14 Victoria.
15 MR SHELDON: If the nurses had said to you, "We are
16 extremely concerned about marks we have found on this
17 child, we have seen what we think may be belt buckle
18 marks, even bite marks, possibly even signs of
19 branding", would you have wanted to have a look at those
20 marks yourself?
21 DR ALEXANDER: It depends on what state the child is in and
22 what she was doing when we were coming in. If I did see
23 that a record of the marks had been made I probably
24 would not do that again. I would not undress the child
25 again just to look at the marks for myself.
141
1 MR SHELDON: You said it depends what state the child is in.
2 How so?
3 DR ALEXANDER: In the sense if the child was walking around
4 without a top or she is just you know come out of
5 somewhere or if she was upset with something else, it
6 depends on the state of -- mental state of the child.
7 Children can be extremely upset when you go for ward
8 rounds and we sometimes do ward rounds without touching
9 a child.
10 MR SHELDON: Absolutely, but Victoria in this instance was
11 well in herself, according to the notes.
12 DR ALEXANDER: That is right.
13 MR SHELDON: So there would have been nothing in her
14 demeanour or mood that would have precluded an
15 examination of marks, was there?
16 DR ALEXANDER: No.
17 MR SHELDON: If you had received news of such extremely
18 worrying marks such as belt buckle marks or bite marks,
19 would it not have been the first and most obvious thing
20 you would have wanted to do to have a look for yourself?
21 DR ALEXANDER: Not necessarily. If myself or the consultant
22 doing the ward round on that day, Dr Meates, was
23 satisfied that the injuries had been recorded I did not
24 feel that you would add any further information, other
25 than satisfying yourself that you have seen it yourself,
142
1 by looking at those injuries again.
2 MR SHELDON: I see, and you were satisfied, were you, that
3 all the injuries on Victoria's body, as of 27th July,
4 had been fully and accurately recorded?
5 DR ALEXANDER: I cannot say that for sure but we did not
6 counter-check because we did not counter-check the body
7 map with the injuries. So what I can say is that it was
8 an assumption that it has been accurately mapped.
9 MR SHELDON: So you simply assumed on the 27th July that
10 everything that needed to be done had been done as far
11 as the recording of injuries was concerned?
12 DR ALEXANDER: That is correct.
13 MR SHELDON: Despite the fact that you had no obvious basis
14 for that assumption?
15 DR ALEXANDER: The basis for that assumption is that there
16 was the body map filled in the previous day.
17 MR SHELDON: Did you have a look at that?
18 DR ALEXANDER: I cannot remember now but you know somebody
19 would have mentioned it to us doing the ward round.
20 MR SHELDON: They would have done, would they?
21 DR ALEXANDER: They would have.
22 MR SHELDON: Because that is what they should have done.
23 DR ALEXANDER: Somebody would have said, if somebody did
24 tell us that there are injuries on this child, which are
25 causing concern as regards to non-accidental injury,
143
1 I would think the logical, you know, next step would be
2 to say that it has been mapped.
3 MR SHELDON: You are responsible as a registrar, are you
4 not, equally with the consultant according to the
5 guidelines in child protection cases, for making sure
6 the case is handled properly?
7 DR ALEXANDER: Absolutely.
8 MR SHELDON: Up until the point that you arrive on the ward
9 as far as you are aware no registrar or consultant has
10 yet examined Victoria to see what marks she has on her
11 body, let alone a full examination of the type that we
12 have been discussing earlier. What did you do to
13 satisfy yourself that the marks were adequately
14 recorded?
15 DR ALEXANDER: I did not do anything else.
16 MR SHELDON: Should you have done something, because one
17 might think this is a golden opportunity -- it is not
18 often that a child may have both a consultant and
19 a registrar standing at her bedside -- and a golden
20 opportunity that would appear to have been missed.
21 DR ALEXANDER: Well, going back, obviously at that stage we
22 did not think, you know, for some reason or the other it
23 was appropriate, but if I am faced with the same
24 situation now I would be more careful in going through
25 these documentation and ensuring that these were
144
1 accurate.
2 MR SHELDON: There is nothing in the notes to indicate why
3 it would have been inappropriate, is there, so is your
4 assumption that it was inappropriate based on the fact
5 that it was not done?
6 DR ALEXANDER: It is based on the fact that you do not
7 undress children and examine them all over again every
8 day but I was unaware that a registrar and a consultant
9 had not you know looked at these injuries in the past,
10 but even now I would certainly not routinely undress
11 a child every day to examine, to do a full examination.
12 MR SHELDON: I can well understand that but that is an
13 entirely different potential set of circumstances to the
14 one we are dealing with here, is it not? Certainly you
15 as a registrar would not repeat the examination done by
16 previous registrars or consultants every day, but if
17 none has yet been done then you have to do one, do you
18 not?
19 DR ALEXANDER: That is correct. That is correct. The only
20 answer I can say to that is that I was unaware or rather
21 the team who did the ward round that day might have been
22 unaware that it was only an SHO who did the body
23 mapping.
24 MR SHELDON: Would you have a look at the body map briefly,
25 which starts at page 60 in that volume. Now, we can see
145
1 on page 60 and the three pages following marks drawn by
2 Dr Reynders and a plan of a child's body indicating
3 where marks are. He describes some as scars, some as
4 swellings, some as tender areas, some as old scars. Is
5 he deficient in his practice in filling out this form by
6 not indicating next to individual marks whether or not
7 he believes it is non-accidental injury? Is that what
8 he should have done or is it quite proper practice to do
9 it in the way he has done it?
10 DR ALEXANDER: I would say that the purpose of a body map is
11 to accurately record what the injuries are and not to
12 give an opinion, so if I were to look back at least and
13 look for deficiencies, I would say my personal practice
14 would be to measure up these swellings and bruised areas
15 and bruised scars but I would certainly not put my
16 opinion or diagnosis against it.
17 MR SHELDON: In that case, for someone who is not medically
18 trained, for example a social worker, those body plans
19 are of absolutely no use at all, are they, unless they
20 are accompanied by a medical opinion as to the cause of
21 those injuries, because without it the social worker
22 will be none the wiser as to whether that shows child
23 abuse or not.
24 DR ALEXANDER: That is right except for the fact that there
25 is an awful lot of scars and bruises on a child of this
146
1 age.
2 MR SHELDON: They could make assumptions or take a guess but
3 they should not be in that position, should they? They
4 should be basing such decisions on medical opinion.
5 DR ALEXANDER: You are right.
6 MR SHELDON: So whatever the case may have been on 27th July
7 as to the recording of the injuries, a critical extra
8 element which was a medical opinion as to how those
9 injuries had come about, that had not yet been provided,
10 had it?
11 DR ALEXANDER: No.
12 MR SHELDON: And that, to put it simply, is where you should
13 have come in, is it not?
14 DR ALEXANDER: In a way, yes. But sometimes diagnoses of
15 non-accidental injuries are made after quite
16 considerable deliberation, looking at these injuries
17 again or trying to get an explanation for the injuries.
18 All I can say is that it will not be -- unless they are
19 very stark it will not be a diagnosis you would give
20 straight away.
21 MR SHELDON: Certainly, but you noted in your ward round
22 note, page 262, that part of the plan was to "inform
23 hospital social worker".
24 DR ALEXANDER: That is right.
25 MR SHELDON: We have already dealt with Dr Meates with the
147
1 point that that had already been done because we can see
2 in the critical incidents log, page 275, a record of the
3 fact that the hospital social worker, Karen Johns, had
4 actually been informed the day before, but I take it
5 that in drafting your plan on the 27th you did not know
6 that?
7 DR ALEXANDER: Probably not.
8 MR SHELDON: Hence the instruction to do it again?
9 DR ALEXANDER: Yes.
10 MR SHELDON: Had you looked at the critical incident log and
11 seen the entry on 26th July, if you have page 275 in
12 front of you, you would have seen that she was to
13 paraphrase asking for medical opinion as to whether the
14 injuries were non-accidental or not, is that right?
15 DR ALEXANDER: Which page?
16 MR SHELDON: 275 in that volume:
17 "Doctors/nurses to contact Social Work Department
18 again if it is thought that injuries are non-accidental
19 and CP forms have been completed stating this."
20 It seems to be that what she was after was some
21 indication from the medical staff that she was dealing
22 with a case of non-accidental injury, does it not?
23 DR ALEXANDER: That is right.
24 MR SHELDON: And that is reinforced by a memo that she wrote
25 which you can find at page 64 of that volume. There she
148
1 says:
2 "Thank you for your referral made yesterday on the
3 26th. I feel it may be helpful to clarify that unless
4 the examining paediatrician has indicated that she or he
5 believes that the injury to the child is likely to be
6 non-accidental, we cannot follow up."
7 So again, on the day that you go on to the ward
8 round the social worker is indicating in this memo that
9 what she needs is paediatric confirmation of suspicions
10 of non-accidental injury, yes?
11 DR ALEXANDER: That is right.
12 MR SHELDON: And she would have got that, would she not,
13 from you had you done an examination or even looked at
14 Victoria's injuries on the 27th July on the ward round?
15 DR ALEXANDER: That is right.
16 MR SHELDON: Because when the social worker, when the nurses
17 or whichever junior doctor you think is going to put in
18 place your plan in the notes phones up Karen Johns on
19 your direction, he is going to be unable to give her the
20 single bit of information it seems that she lacks in
21 order to get things moving, which is that this is a case
22 of non-accidental injury.
23 DR ALEXANDER: That is right. In normal circumstances or in
24 my experience so far, these views are generally
25 transmitted through a written report or a written
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1 medical report detailing the injuries and your opinions
2 and your conclusions on that. And that usually happens
3 at a later stage or when there is a Child Protection
4 Team investigation going on, but certainly we were not
5 aware or we did not look at the particular incident log
6 to find out that that was exactly what Karen Johns
7 needed, is it?
8 MR SHELDON: What would have been the appropriate stage for
9 it to have happened in this case? Come 27th July
10 Victoria has been in hospital three days, the
11 association worker has been informed the day before and
12 has written a memo that day saying please can I be told
13 whether this is non-accidental injury. When do you say
14 would have been the appropriate time to have done what
15 was necessary to enable her to proceed with her work?
16 DR ALEXANDER: As soon as possible.
17 MR SHELDON: Then and there. Turning back to the plan on
18 page 262 to which we have referred, there is nothing
19 there, is there, referring to a meeting with Victoria's
20 mother the next day?
21 DR ALEXANDER: I do not understand you.
22 MR SHELDON: Was it part of your plan on that ward round,
23 albeit not recorded here, that Victoria's mother should
24 be seen as you then thought she should be seen and
25 spoken to next day to discuss concerns about possible
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1 abuse?
2 DR ALEXANDER: Not from what I can see in the notes.
3 MR SHELDON: Volume 5, page 253, please. This is a typed up
4 version of what we understand to be Karen Johns'
5 contemporaneous notes of various contacts with Rainbow
6 Ward in July 1999 and into August. At the top of page
7 253 she makes the following record:
8 "Telephone call to Dr Alexander on 28th July.
9 Confirmed that I had made referral to Haringey but would
10 await contact from them before taking further action.
11 He said that doctors would see mother today at 10 am to
12 share concerns and inform her that a referral had been
13 made to social services."
14 First question is did you say that?
15 DR ALEXANDER: I might have. It is the first time I have
16 seen this.
17 MR SHELDON: You have no recollection of the conversation
18 I take it?
19 DR ALEXANDER: No.
20 MR SHELDON: But in view of the fact that this is as we
21 understand it a contemporaneous note of the conversation
22 then that is likely to be more helpful to the Inquiry
23 than your understandably imperfect recollection of
24 events two years ago.
25 DR ALEXANDER: Yes.
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