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Archived Transcript for 11th October 2001: Pages
1 to 50
1
1 Thursday, 11th October 2001
2 (10.00 am)
3 MR GARNHAM: Good morning, sir. Can I begin by indicating
4 the order in which we propose taking witnesses this
5 morning?
6 THE CHAIRMAN: And some time would you allow me just to make
7 a --
8 MR GARNHAM: Of course, sir. We will, with your leave, sir,
9 take the two witnesses who we did not finish on Thursday
10 first, so it will be Dr Ajayi-Obe first, then
11 Robert Smith, and then Robert Gobin, Paula Johnson,
12 Dr Anita Modi, Marysia Eminowicz and Valerie Tyrrell.
13 THE CHAIRMAN: That is fine. Thank you very much indeed,
14 Mr Garnham, I am grateful for that.
15 Mr Turner, thank you ever so much. I wonder if
16 I could ask you for your help. I am sorry to ask you to
17 do this, but on Tuesday, during the course of the
18 evidence from Mr Armstrong, he made some assertions
19 about practice in Brent which caused me some concern.
20 MR TURNER: Us too, sir.
21 THE CHAIRMAN: I am sure. Of course I have no reason to
22 know whether or not those practices that he referred to
23 are current today, but if they are, it would potentially
24 expose some young people to undue risk, so I wondered,
25 if I were to indicate to you the pages and the reference
2
1 numbers, the line numbers where I had particular
2 concern, whether or not you would be kind enough to
3 cause some enquiries to be made?
4 MR TURNER: I most certainly will, and I hope Miss Okoye
5 will note these. I do not have my notebook in front of
6 me, I regret to say.
7 Can I say, sir, that the matters were obviously of
8 concern to us as well. I have put in hand the
9 commissioning of a statement from Cecelia Hitchen, from
10 whom you may want to hear, and obviously depending on
11 her statement, I will discuss that, if I may, with
12 Mr Garnham, and see whether she is likely to assist.
13 I too was very concerned about the suggestion that
14 either young people were being turned away or that files
15 were still being prematurely closed. I am fairly
16 confident we can deal with these things, sir, but they
17 clearly need to be investigated.
18 THE CHAIRMAN: I am grateful to you. I will just confine
19 myself to three references that I noted. The first is
20 page 193, lines 19 to 25; the next one is page 229,
21 lines 7 to 13; and the third one is page 231, lines 13
22 to 19. Mr Turner, I really am grateful to you. Thank
23 you very much.
24 MR TURNER: Sir, we will do our best.
25 THE CHAIRMAN: Mr Garnham, thank you very much.
3
1 MR GARNHAM: Thank you, sir. I will call Dr Ajayi-Obe,
2 please.
3 DR EKUNDAYO AJAYI-OBE (sworn)
4 MR GARNHAM: Good morning, Doctor. Please have a seat.
5 Would you give the Inquiry your full name, please?
6 DR AJAYE-OBE: My name is Dr Ekundayo Kehinde Ajayi-Obe.
7 MR GARNHAM: And your professional address at present?
8 DR AJAYE-OBE: I am not working presently.
9 MR GARNHAM: Your qualifications, please?
10 DR AJAYE-OBE: I have a Bachelor in Medicine and a Bachelor
11 in Surgery. I also have a Fellowship of the West
12 African College of Physicians and Paediatrics. I have
13 a Masters in Science from Harvard University and I also
14 have a membership of the Royal College of Paediatrics
15 and Child Health.
16 MR GARNHAM: Thank you. You took your Bachelor of Medicine
17 and your Bachelor of Surgery degrees at the University
18 of Ibadan in Nigeria, I think.
19 DR AJAYE-OBE: Yes.
20 MR GARNHAM: And as you have told us, you have the
21 Fellowship of the West African College of Physicians
22 specialising in paediatrics.
23 DR AJAYE-OBE: Yes.
24 MR GARNHAM: Which you have held since 1993.
25 DR AJAYE-OBE: Yes.
4
1 MR GARNHAM: Have you practised in Africa?
2 DR AJAYE-OBE: Yes, I have.
3 MR GARNHAM: Where?
4 DR AJAYE-OBE: Lagos.
5 MR GARNHAM: What experience did you gain, at that time or
6 since, of scabies?
7 DR AJAYE-OBE: I have seen a few cases of scabies.
8 MR GARNHAM: Thank you. We are concerned particularly,
9 Doctor, with your evidence about the events of
10 14th July 1999. You have made a statement for our
11 purposes -- sir, which we find at page 77 in volume 5 --
12 I wonder if you could be shown that. Would you look at
13 that statement, please, and confirm that you have signed
14 it?
15 DR AJAYE-OBE: Yes.
16 MR GARNHAM: And that the contents of that statement are
17 true?
18 DR AJAYE-OBE: Yes, except for one thing I just want to --
19 MR GARNHAM: Well, if you would like to make a correction,
20 please do so now.
21 DR AJAYE-OBE: I said it was a left bloodshot eye. Actually
22 going through my notes, it was both of them.
23 MR GARNHAM: Thank you very much. Sir, Dr Obe has also made
24 a statement for the CPS, which is at volume 46, page 1,
25 and a transcript of her evidence at the Central Criminal
5
1 Court is in volume 49, page 23. Doctor, I may get you
2 to look at those documents in a moment, but for the
3 present, perhaps you would start with your statement.
4 On 14th July, you were a locum paediatric registrar
5 at the Central Middlesex Hospital.
6 DR AJAYE-OBE: Yes.
7 MR GARNHAM: How long, by then, had you been at CMH?
8 DR AJAYE-OBE: 12 days.
9 MR GARNHAM: In those 12 days, had you become aware of the
10 CMH child protection procedures?
11 DR AJAYE-OBE: No.
12 MR GARNHAM: Would you normally, if working as a locum, go
13 through any induction process?
14 DR AJAYE-OBE: No.
15 MR GARNHAM: And you did not go through any such process at
16 CMH?
17 DR AJAYE-OBE: No, I did not.
18 MR GARNHAM: Have you since 14th July seen any of the
19 documents setting out child protection procedures for
20 the CMH?
21 DR AJAYE-OBE: No.
22 MR GARNHAM: Working as a locum, presumably you will have
23 worked at a number of different hospitals?
24 DR AJAYE-OBE: Yes.
25 MR GARNHAM: Did you see child protection guidelines and
6
1 procedures at other hospitals?
2 DR AJAYE-OBE: Yes.
3 MR GARNHAM: I imagine you can only speak in generalities,
4 but in general, are the child protection procedures at
5 different NHS hospitals similar?
6 DR AJAYE-OBE: Yes.
7 MR GARNHAM: When you began work at CMH, did you anticipate
8 needing any different procedures in respect of child
9 protection there than you would at any other hospital?
10 DR AJAYE-OBE: No.
11 MR GARNHAM: If you had before you a case where child
12 protection concerns were raised, would you expect to
13 fill in some form of form?
14 DR AJAYE-OBE: Yes.
15 MR GARNHAM: Did you know where to find them at CMH?
16 DR AJAYE-OBE: I asked for them and I was given them.
17 MR GARNHAM: So when the particular case with which we are
18 concerned came up, you asked for forms.
19 DR AJAYE-OBE: Yes.
20 MR GARNHAM: But you did not know where they were in
21 advance?
22 DR AJAYE-OBE: No.
23 MR GARNHAM: Were they readily available when you asked?
24 DR AJAYE-OBE: They went to look for them. I started seeing
25 the child, and they went to look for them.
7
1 MR GARNHAM: And found them, and brought them to you?
2 DR AJAYE-OBE: And found them, and brought them to me.
3 MR GARNHAM: You explain in your statement what you would do
4 after completing child protection forms in any case,
5 where you had concerns about a child, and I think your
6 normal practice would be to inform a consultant?
7 DR AJAYE-OBE: Yes.
8 MR GARNHAM: To ask to see the Child Protection Register?
9 DR AJAYE-OBE: Yes.
10 MR GARNHAM: And then you use these words: "automatically
11 contact Social Services".
12 DR AJAYE-OBE: I would go through the switchboard to contact
13 them, yes.
14 MR GARNHAM: I am interested in the use of the word
15 "automatically". Can you explain what you had in mind?
16 DR AJAYE-OBE: As soon as I -- I would want to double check
17 even if I did not find the child on the child register,
18 I would want to double check with the social workers,
19 just to make sure that they were not aware of the child
20 as well.
21 MR GARNHAM: So you mean it would be a matter of your
22 regular practice to do that?
23 DR AJAYE-OBE: Yes.
24 MR GARNHAM: Some time after noon on 14th July, I think you
25 were bleeped by a senior house officer.
8
1 DR AJAYE-OBE: Yes.
2 MR GARNHAM: Who was that?
3 DR AJAYE-OBE: I believe it was Dr Beynon.
4 MR GARNHAM: Thank you. Do you remember what he told you?
5 DR AJAYE-OBE: He told me that there was a child that he
6 suspected had non-accidental injury.
7 MR GARNHAM: Did he identify what those injuries were?
8 DR AJAYE-OBE: From what I remember, he did say that she had
9 multiple bruises, or multiple injuries.
10 MR GARNHAM: Do you remember which it was, was it multiple
11 injuries or multiple bruises, or both, or neither?
12 DR AJAYE-OBE: I cannot actually remember completely, but he
13 said multiple -- bruises, but injuries and bruises,
14 I cannot remember.
15 MR GARNHAM: You make mention in your statement that you
16 were told by him about bloodshot eyes; do you recall
17 that?
18 DR AJAYE-OBE: I am not 100 per cent sure.
19 MR GARNHAM: First of all, do you recall that you put that
20 in your statement?
21 DR AJAYE-OBE: Yes, I do.
22 MR GARNHAM: Secondly, do you have any independent
23 recollection of being told that back in July 1999?
24 DR AJAYE-OBE: No.
25 MR GARNHAM: Are you now able to say whether he talked to
9
1 you about a single bloodshot eye or bloodshot eyes
2 plural?
3 DR AJAYE-OBE: I would have said it was plural if he did
4 say.
5 MR GARNHAM: And that is because you have gone back to look
6 at the notes?
7 DR AJAYE-OBE: Yes.
8 MR GARNHAM: Victoria was sent to Barnaby Bear Ward with
9 a neighbour, Mrs Cameron.
10 DR AJAYE-OBE: Yes.
11 MR GARNHAM: And that is where you were, is it?
12 DR AJAYE-OBE: Yes, I was there.
13 MR GARNHAM: And you tell us that you examined her in a bed
14 space; what is a bed space? Is there a bed there?
15 DR AJAYE-OBE: There was a bed there, yes.
16 MR GARNHAM: How did Victoria seem in herself when you first
17 met her?
18 DR AJAYE-OBE: She was a jolly child. I mean, from what
19 I described, she was -- it did not suggest that she was
20 depressed or she was --
21 MR GARNHAM: Distressed?
22 DR AJAYE-OBE: Distressed, no. When I actually saw her, she
23 did not look distressed.
24 MR GARNHAM: She was quite a jolly child?
25 DR AJAYE-OBE: Yes.
10
1 MR GARNHAM: Do you remember whether she was scratching
2 herself?
3 DR AJAYE-OBE: I cannot remember if she was scratching
4 herself, but I know she did comment about scratching.
5 MR GARNHAM: She commented about scratching?
6 DR AJAYE-OBE: She did not say scratching, but when I asked
7 her the reason for the injuries on her body, she said
8 that she started itching and scratching; she
9 demonstrated.
10 MR GARNHAM: I see. What I was interested in is whether
11 she, before being asked, was scratching herself.
12 DR AJAYE-OBE: I cannot recollect.
13 MR GARNHAM: Can I ask you to look at two documents, please?
14 You will need volumes 46 and 49 for this. Volume 46
15 first, page 2; do you have that?
16 DR AJAYE-OBE: Yes.
17 MR GARNHAM: That is your CPS statement. About halfway down
18 the second page, halfway through the text, do you see
19 the sentence that begins:
20 "During the examination ..."?
21 DR AJAYE-OBE: Yes.
22 MR GARNHAM: "During the examination she was observed to be
23 scratching herself and when asked why she was doing it,
24 she said she was itchy."
25 Do you see that?
11
1 DR AJAYE-OBE: Yes.
2 MR GARNHAM: That is what you said to the CPS. Can I then,
3 before I ask you about that, ask you to look at the
4 other volume, volume 49, and at page 32? Do you have
5 that?
6 DR AJAYE-OBE: Yes.
7 MR GARNHAM: That is part of the transcript of the evidence
8 you gave at the Old Bailey, and just opposite the first
9 punch hole, you see an answer about her clothes, and
10 then the question:
11 "Was that the clothes alone or her as well?
12 "Answer: Her as well, she looked unclean.
13 "Question: Was she touching herself in any way?
14 "Answer: No."
15 On the face of it, those seem a little inconsistent,
16 and I simply want to ask you about that. In the CPS
17 statement, you say that during the examination you saw
18 her scratching herself; to the jury at the Old Bailey,
19 you said that she did not appear to be touching herself.
20 Are you able to help us with that any more?
21 DR AJAYE-OBE: Well, when it came to writing my statement,
22 I only had about 45 minutes to read the case notes.
23 MR GARNHAM: Which statement is that?
24 DR AJAYE-OBE: The CPS one, I only had 45 minutes to read
25 it, and they were pressing me to write the statement, so
12
1 I did not actually study those notes properly, and that
2 is why, when it came to the left -- one bloodshot eye,
3 actually when I look back, I got the photocopies of the
4 notes in May, and it was only when I looked back that
5 I actually saw.
6 MR GARNHAM: Thank you. With a helpful prompt from my
7 learned friend, can I ask you, while you are in
8 volume 49, also to look at page 36? Opposite the
9 letter F:
10 "Answer: I asked her how she cut her hands and she
11 said she did it herself.
12 "Question: She did it herself?
13 "Answer: Yes, scratching because it was itching
14 her. 'That is what she said.
15 "Question: She was telling you by communicating --
16 by doing this (indicating)?
17 "Answer: Yes.
18 "Question: That she had done it herself --
19 "Answer: Yes.
20 "Question: By scratching?
21 "Answer: Yes."
22 I will come on to that, but it is not quite the same
23 point. I will come on to what she told you she did in
24 a moment, but I am interested in what you observed.
25 There appears to be, does there not, something of
13
1 a conflict between your saying she did not touch herself
2 while you were examining her and you saying in the CPS
3 statement that she was scratching herself?
4 DR AJAYE-OBE: As I said, I only had very little time to go
5 through the statement -- through the case notes, and it
6 is only having gone through it now closely that I found
7 out that she actually was not scratching -- she did talk
8 about scratching, but it was more when I actually
9 prompted her.
10 MR GARNHAM: I see, so in that regard at least, we should
11 regard your present statement for this Inquiry and your
12 evidence to the trial as more reliable than your shortly
13 prepared statement for the CPS?
14 DR AJAYE-OBE: Yes.
15 MR GARNHAM: Thank you. The information that you received
16 from Victoria was first recorded on the ward clerking
17 notes, I think.
18 DR AJAYE-OBE: Yes.
19 MR GARNHAM: Could you have volume 37, please? If you would
20 go to page 24, is this the start of the clerking notes?
21 DR AJAYE-OBE: Yes.
22 MR GARNHAM: I am going to need to ask you quite a lot about
23 that, and it may be as well that we have on the
24 transcript a proper interpretation of your handwriting,
25 although I think you probably get the prize as the most
14
1 legible of the doctors' handwriting, but nonetheless, to
2 avoid doubt, can I ask you simply to read through your
3 notes?
4 DR AJAYE-OBE: Okay:
5 "Presenting complaint: Anna Kouro, aged 7 years.
6 Date of birth: not known. French speaking/African.
7 Complaint: multiple bruises and scars all over the body.
8 A month ago, Anna's mum came knocking on the carer's
9 door," that was a Saturday evening, "desperate to leave
10 Anna with somebody for the following Monday.
11 Arrangements were made for a sum of money and started on
12 the" -- I did not complete that sentence.
13 MR GARNHAM: I see, "started on the" blank.
14 DR AJAYE-OBE: Yes. "She said she was starting English
15 classes."
16 This is the format over the five weeks for which she
17 actually went to the carers.
18 MR GARNHAM: So we have first week, Monday to Saturday,
19 "Dropped her 6.00 to 11.00 am in the morning."
20 DR AJAYE-OBE: "And picked her up between 7.00 and 9.00 at
21 night." The times were well kept.
22 MR GARNHAM: Second week, Monday to Friday?
23 DR AJAYE-OBE: Yes, she could not tell me the times.
24 MR GARNHAM: Third week, Monday to Friday?
25 DR AJAYE-OBE: Monday to Thursday. "Did not come on the
15
1 Friday of that week. Having problems with the
2 landlord."
3 MR GARNHAM: Fourth week?
4 DR AJAYE-OBE: Monday to Wednesday, and fifth week, Tuesday
5 night, presented on Wednesday.
6 MR GARNHAM: And then?
7 DR AJAYE-OBE: "Mum stays in a bed and breakfast hostel,
8 either 6 or 8 Nicoll Road, housed by Ealing Borough, but
9 this has possibly been withdrawn. Carer says Anna's mum
10 asked her to help her read a letter from borough. Wants
11 to send her back to France. Mum speaks some English,
12 cannot read French."
13 MR GARNHAM: Do you mean that?
14 DR AJAYE-OBE: "Cannot read", sorry.
15 "French speaking citizen of France."
16 MR GARNHAM: Then your physical examination over the page.
17 "Claims mum is in her mid 40s"?
18 DR AJAYE-OBE: "To late 40s. Anna says she is from Ivory
19 Coast (Abidjan). Anna born in France".
20 MR GARNHAM: Before you read that, what is the --
21 DR AJAYE-OBE: "Family and social history."
22 MR GARNHAM: Thank you.
23 DR AJAYE-OBE: "Anna born in France. Parents separated.
24 Anna taken back to Ivory Coast by father. Dad died,
25 Anna looked after by grandmum. Not sure if paternal
16
1 maternal. Grandmother died, mum went to collect Anna
2 from Ivory Coast and brought to France. Recently
3 brought over to London. Possibly been with mum for
4 approximately three months", and then there is a chart
5 here. There is: Dad, Mum ...
6 MR GARNHAM: Yes, I do not think I need to trouble you with
7 that. Next page?
8 DR AJAYE-OBE: "Last night, i.e. Tuesday night, brought her
9 over to carer's house about 9.45 with Anna's belongings.
10 Said she was desperate to leave Anna, had to go
11 somewhere. Also it was thought the landlord did not
12 want Anna in the house. She stayed with carer. Anna's
13 mum came to the carer's house this morning and dropped
14 some of her things in the hallway," that is the hall of
15 the carer's house, "and said she had to go some places
16 today to sort out her housing situation. Bruises/scars
17 noticed by daughter of carer. Brought in this morning.
18 Carer asked Anna who inflicted bruises and scars. Anna
19 said she, i.e Anna herself, was the one who did it.
20 I the doctor (inaudible) asked Anna" --
21 MR GARNHAM: Sorry, where is --
22 DR AJAYE-OBE: Anna said she was the one who did it, i.e.
23 Anna herself. I the doctor (inaudible) asked Anna said
24 she scratched herself. Did not know about the cuts on
25 her hands. She denies the fact that anyone beat her.
17
1 Very secretive child."
2 MR GARNHAM: Thank you very much. We can see from the first
3 page and the first line you read that you were given the
4 name "Anna Kouro", is that right?
5 DR AJAYE-OBE: Yes.
6 MR GARNHAM: And you have recorded that when you completed
7 these notes?
8 DR AJAYE-OBE: Yes.
9 MR GARNHAM: When did you complete the notes? How long
10 after the examination, or was it during the examination?
11 DR AJAYE-OBE: Well, this was during the examination.
12 I wrote these notes during the examination.
13 MR GARNHAM: So you write as you are talking to the patient?
14 DR AJAYE-OBE: Yes.
15 MR GARNHAM: Thank you. Would you have now volume 38,
16 please, page 154? Do we have there a girl's growth
17 assessment chart?
18 DR AJAYE-OBE: Yes.
19 MR GARNHAM: And do we see at the top of that page "Anna
20 Kouro" as the name? The date of birth is crossed out,
21 but you have "7 years" written in?
22 DR AJAYE-OBE: Yes.
23 MR GARNHAM: That is what that symbol means, is it, seven
24 years? There is nothing I have missed off from that?
25 DR AJAYE-OBE: No.
18
1 MR GARNHAM: Then if you go over the page to 155, we see
2 where you have put two crosses.
3 DR AJAYE-OBE: Yes.
4 MR GARNHAM: One of them is on the weight scale and the
5 other is on the height scale. Do you need some help?
6 DR AJAYE-OBE: Yes, please.
7 MR GARNHAM: I wonder if our witness manager or Jean could
8 help with the microphone.
9 DR AJAYE-OBE: Yes.
10 MR GARNHAM: Thank you very much. You have put one cross on
11 the weight scale and one on the height scale; against
12 what age?
13 DR AJAYE-OBE: That is a 7 there, and that is a 7.
14 MR GARNHAM: They are both against the age 7?
15 DR AJAYE-OBE: Yes.
16 MR GARNHAM: That being the age you were told Victoria was?
17 DR AJAYE-OBE: Yes.
18 MR GARNHAM: Doctor, Mrs Cameron, when she gave evidence to
19 this Inquiry a few days ago, described to us how she saw
20 a piece of skin hanging from the eyelid above one of
21 Victoria's eyes. Did you see that?
22 DR AJAYE-OBE: No.
23 MR GARNHAM: She also described a wound the size of a penny
24 on her cheek, on her face. Did you see that?
25 DR AJAYE-OBE: There was a wound, yes, on her face.
19
1 MR GARNHAM: Can I ask you a little about what Mrs Cameron
2 said to you? How did she describe Victoria's behaviour
3 when she, Victoria, was in the Camerons' care?
4 DR AJAYE-OBE: Well, she described that she was jolly,
5 bubbly, she loved singing, loved dancing, and she
6 interacted well with them, her mother's grandchildren.
7 MR GARNHAM: Did she talk about whether Victoria was at
8 school?
9 DR AJAYE-OBE: She told me she was not at school.
10 MR GARNHAM: Did she talk about Victoria's continence,
11 whether she was continent of urine and faeces?
12 DR AJAYE-OBE: The only thing she said was that there was
13 once she wet herself during the day, I think she was
14 sleeping and she wet herself.
15 MR GARNHAM: Thank you.
16 DR AJAYE-OBE: And she did say that the mum -- I think
17 someone had complained that she bed wet.
18 MR GARNHAM: Thank you. Were you told how Victoria and her
19 "mother" got along?
20 DR AJAYE-OBE: She told me that her mum -- she had never
21 seen her hit her, but she said that she had spoken
22 harshly to her.
23 MR GARNHAM: Did you notice when you first saw Victoria
24 whether any of her teeth were missing?
25 DR AJAYE-OBE: No.
20
1 MR GARNHAM: Would you have noticed were there teeth
2 missing?
3 DR AJAYE-OBE: I would have noticed if the front teeth were
4 missing, yes.
5 MR GARNHAM: What about the incisors?
6 DR AJAYE-OBE: Yes, I would have noticed.
7 MR GARNHAM: So you are confident there were none missing?
8 DR AJAYE-OBE: Yes.
9 MR GARNHAM: How were you and Victoria able to communicate?
10 Do you speak French?
11 DR AJAYE-OBE: Not very well.
12 MR GARNHAM: How much English did Victoria have?
13 DR AJAYE-OBE: A few scattered words.
14 MR GARNHAM: In the clerking notes we have looked at,
15 volume 37, page 25, you say in the second paragraph:
16 "Anna says she is from Ivory Coast."
17 DR AJAYE-OBE: It was actually Abidjan she said, and I knew
18 that Abidjan was in Ivory Coast.
19 MR GARNHAM: I see, but you asked Anna where she came from?
20 DR AJAYE-OBE: Well, I asked about France, and then
21 France -- I said Africa, and she said "Abidjan".
22 MR GARNHAM: So she could recognise that much of the sense
23 of what you were saying?
24 DR AJAYE-OBE: Yes.
25 MR GARNHAM: You say in paragraph 20 of your statement that
21
1 during your examination of Victoria, Mrs Cameron asked
2 Victoria who inflicted the bruising and scarring; is
3 that right?
4 DR AJAYE-OBE: Yes.
5 MR GARNHAM: And that Victoria said that she did it herself?
6 DR AJAYE-OBE: Yes.
7 MR GARNHAM: Was all of that in English?
8 DR AJAYE-OBE: That was -- it was more in English it was
9 "self, self". She just mentioned a few words, just
10 scatty words.
11 MR GARNHAM: But she understood the question?
12 DR AJAYE-OBE: Yes, because I demonstrated it non-verbally
13 as well.
14 MR GARNHAM: I can see that that would help, but it is
15 difficult to ask a child who speaks no English
16 a question such as, "Who caused these injuries?" The
17 concept of causing is not easily got over by hand
18 signals.
19 DR AJAYE-OBE: In my interaction with her, I believe that
20 she understood what I was saying. I did say she was
21 much more mature than a seven year old girl.
22 MR GARNHAM: The picture if I am getting from you, correct
23 me if I am wrong, is that she was understanding more
24 English than she was speaking?
25 DR AJAYE-OBE: Yes.
22
1 MR GARNHAM: Would that be fair?
2 DR AJAYE-OBE: I would say -- I think a combination of
3 things, non-verbal, verbal, a few words here and there
4 I believe she understood.
5 MR GARNHAM: Thank you. In particular you remember Victoria
6 using the word "scratch", the English word "scratch"?
7 DR AJAYE-OBE: Yes.
8 MR GARNHAM: Thank you. You say in paragraph 9 of your
9 statement that you noticed that Victoria looked unkempt
10 and seemed unwashed.
11 DR AJAYE-OBE: Yes.
12 MR GARNHAM: And that she gave off a pungent smell.
13 DR AJAYE-OBE: Yes.
14 MR GARNHAM: Apart from the obvious that she had not washed
15 or her clothes had not been washed, what else did you
16 get from that?
17 DR AJAYE-OBE: She just looked generally unkempt.
18 MR GARNHAM: Were you concerned whether she was being cared
19 for properly?
20 DR AJAYE-OBE: Yes, I was.
21 MR GARNHAM: Was it the sort of body odour that one would
22 expect from a day's non-washing, or was it more pungent
23 than that?
24 DR AJAYE-OBE: I would say it was more pungent than that.
25 MR GARNHAM: In the case of a seven year old girl, absent
23
1 neglect, is there any obvious explanation for why she
2 should smell in the way that she did?
3 DR AJAYE-OBE: No.
4 MR GARNHAM: Can I ask you about each of the injuries you
5 noticed, please? First, the bloodshot eye, although you
6 now say it is bloodshot eyes, plural.
7 DR AJAYE-OBE: Yes.
8 MR GARNHAM: Was that immediately noticeable as soon as you
9 saw the child?
10 DR AJAYE-OBE: Yes.
11 MR GARNHAM: Can you describe how serious, how severe or
12 non-severe it was?
13 DR AJAYE-OBE: It was the medial aspect of the white of the
14 eye.
15 MR GARNHAM: So the part nearest the nose?
16 DR AJAYE-OBE: Exactly, both.
17 MR GARNHAM: In the conjunctiva?
18 DR AJAYE-OBE: Yes.
19 MR GARNHAM: So that is in the white of the eye?
20 DR AJAYE-OBE: Yes.
21 MR GARNHAM: Was it the sort of redness that one can get
22 from crying or rubbing one's eyes?
23 DR AJAYE-OBE: It looked like she had bled into it.
24 MR GARNHAM: So there is some sort of damage to a blood
25 vessel, causing bleeding into the conjunctiva?
24
1 DR AJAYE-OBE: Yes.
2 MR GARNHAM: What are the possible causes for that?
3 DR AJAYE-OBE: Various causes. Could be she -- if she had
4 whooping cough for instance she could have it. Could
5 be -- some violence or the other it could be.
6 MR GARNHAM: Is it indicative of some form of trauma
7 sufficient to break a vessel?
8 DR AJAYE-OBE: I do not know of any specific trauma. I am
9 not an expert at that.
10 MR GARNHAM: Right, but the possible causes that occur to
11 you are either whooping cough or some form of trauma?
12 DR AJAYE-OBE: Yes.
13 MR GARNHAM: Anything else?
14 DR AJAYE-OBE: No, probably -- well, if it had been somebody
15 who had had some head injury or other. It could also
16 have been severe conjunctivitis.
17 MR GARNHAM: Tell us what that is, please?
18 DR AJAYE-OBE: An infection of the conjunctiva itself, but
19 you would expect the eyes to be inflamed.
20 MR GARNHAM: And they were not?
21 DR AJAYE-OBE: No.
22 MR GARNHAM: The redness in the eyes was more than the sort
23 you would get from having a cold?
24 DR AJAYE-OBE: Yes.
25 (10.30 am)
25
1 MR GARNHAM: Finally on this, the question of the eyes,
2 could it be the result of a spontaneous burst of a blood
3 vessel?
4 DR AJAYE-OBE: It is possible.
5 MR GARNHAM: What prompts, causes a spontaneous burst of
6 a blood vessel in the eye?
7 DR AJAYE-OBE: Some form of raised pressure.
8 MR GARNHAM: Thank you. Which in itself is caused by some
9 sort of medical condition?
10 DR AJAYE-OBE: Not necessarily.
11 MR GARNHAM: What else can cause it? Can it just happen in
12 the ordinary course of a child's life?
13 DR AJAYE-OBE: I am not an expert at that.
14 MR GARNHAM: Thank you. Next, Victoria's hands and fingers;
15 can you just describe in your own words what the state
16 of her fingers was?
17 DR AJAYE-OBE: I noticed multiple cuts, small cuts, some
18 a bit more than others on her hands.
19 MR GARNHAM: Some bigger --
20 DR AJAYE-OBE: Some bigger than others.
21 MR GARNHAM: Clean or infected?
22 DR AJAYE-OBE: Some were infected, I believe.
23 MR GARNHAM: How was that infection demonstrated?
24 DR AJAYE-OBE: There was yellow crusting.
25 MR GARNHAM: Is that the result of pus?
26
1 DR AJAYE-OBE: Not necessarily from pus, but there was
2 yellow crusting, which I put down to infection.
3 MR GARNHAM: The most severe of these cuts, can you describe
4 first of all where that was?
5 DR AJAYE-OBE: Can I just get my --
6 MR GARNHAM: Yes, do.
7 DR AJAYE-OBE: There was a cut on her left hand, the palm
8 aspect, between the thumb and the first finger, and that
9 was a deep -- that was the biggest of them.
10 MR GARNHAM: In the web or on the palm of the hand?
11 DR AJAYE-OBE: It was on the palm.
12 MR GARNHAM: Thank you. The deeper of the cuts that you
13 saw, and the infected cuts, would you describe those as
14 superficial scratches?
15 DR AJAYE-OBE: No.
16 MR GARNHAM: Were they more than that?
17 DR AJAYE-OBE: Yes.
18 MR GARNHAM: Could they have been self-inflicted?
19 DR AJAYE-OBE: Could have been.
20 MR GARNHAM: And how might a child cause those injuries to
21 herself?
22 DR AJAYE-OBE: Well I know the possibility of a razor blade
23 was mentioned, not directly to me.
24 MR GARNHAM: That was my next question; did anybody suggest
25 razor blades to you?
27
1 DR AJAYE-OBE: No.
2 MR GARNHAM: Could razor blades have done this?
3 DR AJAYE-OBE: Yes.
4 MR GARNHAM: Could it have been done with razor blades by
5 the child herself?
6 DR AJAYE-OBE: Yes, possible.
7 MR GARNHAM: Physically possible? There was nothing that
8 was outside the reach of one hand or the other?
9 DR AJAYE-OBE: No.
10 MR GARNHAM: Likely?
11 DR AJAYE-OBE: In my own experience, I have not seen any
12 child inflict his or herself with a razor blade.
13 MR GARNHAM: Thank you. Could it be done by scratching?
14 Could this cut be produced by scratching?
15 DR AJAYE-OBE: No.
16 MR GARNHAM: Next, please, the marks and injuries on the
17 body, and for this purpose, I would like you to look,
18 please, in volume 37 at page 21. I wonder if I might
19 have that on the screen. While that is going on,
20 Doctor, you have looked at it; can you tell us what it
21 is?
22 DR AJAYE-OBE: It is a body chart.
23 MR GARNHAM: Prepared by whom?
24 DR AJAYE-OBE: Myself.
25 MR GARNHAM: Can we move it down so we can see the two sides
28
1 of the face, please? Can you tell us what you are
2 drawing there, please?
3 DR AJAYE-OBE: That is the right and left side of her face,
4 and I have just outlined the injuries.
5 MR GARNHAM: Thank you. I will come back to that in
6 a moment. Can we now go to the rest of the body by
7 sliding the photograph down? Thank you. That similarly
8 shows the marks to the front and back of Victoria's
9 trunk, does it?
10 DR AJAYE-OBE: Yes.
11 MR GARNHAM: For some reason, the witness's screen is not
12 on, she is having to strain to look at the television
13 screen. I wonder if we could put that on for her,
14 please.
15 While that is being done, if you would look at the
16 drawing in the files, please? This body plan of the
17 front and back of Victoria records what type of
18 injuries?
19 DR AJAYE-OBE: Records the injuries on her body, scars.
20 MR GARNHAM: All injuries?
21 DR AJAYE-OBE: A large majority of them.
22 MR GARNHAM: In the criminal trial, you appeared to
23 distinguish between bruising, scratches and grazing.
24 I can take you to that if necessary, but do you remember
25 you made that distinction?
29
1 DR AJAYE-OBE: Yes.
2 MR GARNHAM: Does this body plan purport to record all those
3 three, bruises, scratches and grazes?
4 DR AJAYE-OBE: I would say yes, but not -- I would not be
5 able to identify --
6 MR GARNHAM: Which they are?
7 DR AJAYE-OBE: Yes.
8 MR GARNHAM: So that we are clear, explain what you
9 understand to be the difference between bruise, scratch
10 and graze. Bruise, first of all.
11 DR AJAYE-OBE: A bruise, I would say, would be a contusion
12 of the skin -- a contusion of the skin with no break --
13 there is no abrasion, no breach in the skin itself, and
14 it could be that there would be some bleeding into the
15 skin. It would be -- initially, in the beginning, it
16 would be some discolouration, there could be some
17 swelling, and there could be some tenderness as well.
18 MR GARNHAM: And thereafter, as time passes?
19 DR AJAYE-OBE: You would just see the discolouration.
20 MR GARNHAM: Thank you. Scratching; how is that seen?
21 DR AJAYE-OBE: Scratching would be more of the imprints of
22 the nails, just thin linear lines.
23 MR GARNHAM: Breaking the skin or not breaking the skin or
24 either?
25 DR AJAYE-OBE: Could break the skin, may not.
30
1 MR GARNHAM: And grazing?
2 DR AJAYE-OBE: That would be more just the surface of the
3 skin being removed.
4 MR GARNHAM: Thank you. You cannot tell us immediately
5 which of those three these marks represent?
6 DR AJAYE-OBE: No, except for one or two.
7 MR GARNHAM: Which ones can you tell us about?
8 DR AJAYE-OBE: The one on the face.
9 MR GARNHAM: I want to come back to the face in a moment.
10 What about the one on the child's left hand?
11 DR AJAYE-OBE: Is it on --
12 MR GARNHAM: It is ringed with a circle. We will focus in
13 on it.
14 DR AJAYE-OBE: That is a cut.
15 MR GARNHAM: That is the cut you described to me earlier, is
16 it?
17 DR AJAYE-OBE: Yes.
18 MR GARNHAM: Can we pull back again, please? Can you go to
19 the hands on the right hand picture? Can you help us
20 with what that is?
21 DR AJAYE-OBE: That was a haematoma.
22 MR GARNHAM: Bruising?
23 DR AJAYE-OBE: Yes, more of a small bruise.
24 MR GARNHAM: And the other hand?
25 DR AJAYE-OBE: That was an infected cut.
31
1 MR GARNHAM: And where are you indicating the infected cut?
2 DR AJAYE-OBE: There are various ones.
3 MR GARNHAM: So it is cuts plural; sorry, I missed that.
4 Can we then go to the pictures at the top, of the
5 face? You said at the criminal trial, and again I can
6 take you to this if you need to be reminded of it, that
7 the bruising was mostly on the face; is that right?
8 DR AJAYE-OBE: Yes.
9 MR GARNHAM: There were injuries to each side of the ear and
10 adjacent to the eyebrow, you said; can we deal with
11 where the injuries are to each side of the ear?
12 DR AJAYE-OBE: There is one on -- just in front of the ear
13 on the right side.
14 MR GARNHAM: This is the picture with the R, where we are
15 focusing in on now?
16 DR AJAYE-OBE: Yes, and there is just one slightly below it.
17 MR GARNHAM: And one below the lobe?
18 DR AJAYE-OBE: Yes.
19 MR GARNHAM: Those are the two you were referring to. What
20 sort of injuries were they?
21 DR AJAYE-OBE: I cannot remember.
22 MR GARNHAM: Can we pull back a little on the photograph,
23 please? On the right-hand side of her face, if we focus
24 in on that, and up a little, above the eye, there
25 appears to be a circle drawn. What is that?
32
1 DR AJAYE-OBE: That was a bruise, a graze.
2 MR GARNHAM: The reason I ask about that is that would
3 appear to be approximately in the position Mrs Cameron
4 described this loose piece of skin, but you saw no loose
5 piece of skin, you saw a graze?
6 DR AJAYE-OBE: I cannot remember seeing a loose piece of
7 skin, no.
8 MR GARNHAM: Thank you. Look at, if we may, please, the
9 other side of the face, which I think is the left.
10 There is a mark to the left of the child's eyebrow; do
11 you remember what that was?
12 DR AJAYE-OBE: No.
13 MR GARNHAM: You cannot remember whether that is a bruise,
14 a scratch or a graze?
15 DR AJAYE-OBE: No.
16 MR GARNHAM: Do you remember whether there were any
17 scratches to the face, as opposed to grazes and bruises?
18 DR AJAYE-OBE: I cannot remember. There might have been.
19 MR GARNHAM: Thank you very much. Can we pull back to the
20 whole of the picture again, please? Thank you. The
21 neck, were there marks on the neck?
22 DR AJAYE-OBE: There is one charted on the right side. So
23 that could have been a ...
24 MR GARNHAM: Is that what we are focusing in on now?
25 DR AJAYE-OBE: Yes.
33
1 MR GARNHAM: If we move a little to the right of that, we
2 see what I think is "hyp pigmented graze".
3 DR AJAYE-OBE: Yes.
4 MR GARNHAM: Is it hyper or hypo?
5 DR AJAYE-OBE: Hypo.
6 MR GARNHAM: For those of us who have forgotten, can you
7 just remind us which is hypo and which is hyper?
8 DR AJAYE-OBE: Hypo is pale discolouration and hyper is a
9 dark discolouration.
10 MR GARNHAM: Thank you. And which was that?
11 DR AJAYE-OBE: That was the light one, the pale one.
12 MR GARNHAM: And you are indicating there, are you, the mark
13 immediately adjacent to the mouth?
14 DR AJAYE-OBE: Yes.
15 MR GARNHAM: And that was a graze?
16 DR AJAYE-OBE: Yes.
17 (10.45 am)
18 MR GARNHAM: Can we go back to the full body picture,
19 please? Then we can see on the left hand picture, on
20 the right arm of the child, if we focus in on that,
21 please -- higher -- and go to the right of the right
22 nipple, we see there some marks on her shoulder and arm;
23 do you recall those?
24 DR AJAYE-OBE: Yes.
25 MR GARNHAM: Can you tell us what they were?
34
1 DR AJAYE-OBE: I believe they were grazes.
2 MR GARNHAM: Thank you. Can we go back to the whole picture
3 again, please, and to the picture that shows Victoria's
4 back, legs and buttocks, thank you. What do we see
5 there on her legs and buttocks?
6 DR AJAYE-OBE: I cannot quite remember what they actually
7 were.
8 MR GARNHAM: The injuries on the buttocks, were they of one
9 of the three types you have identified, grazing
10 scratching or bruising?
11 DR AJAYE-OBE: Yes.
12 MR GARNHAM: It was not a form of nappy rash?
13 DR AJAYE-OBE: No.
14 MR GARNHAM: Can we go back to the whole picture again,
15 please? How many of these injuries, by description or
16 percentage or however you like, could have been
17 self-inflicted, in your opinion? Some, all, none?
18 DR AJAYE-OBE: Some.
19 MR GARNHAM: Some could have been self-inflicted but not
20 all?
21 DR AJAYE-OBE: Not all.
22 MR GARNHAM: You asked Victoria what was the cause of the
23 bruising and she said scratching.
24 DR AJAYE-OBE: Yes.
25 MR GARNHAM: Sir, for your note, that question is put in the
35
1 criminal trial at 49/040.
2 Can scratching cause bruising?
3 DR AJAYE-OBE: Not that I know of. I do not know. Maybe
4 intense --
5 MR GARNHAM: But it is not the obvious mechanism for the
6 cause of a bruise?
7 DR AJAYE-OBE: No.
8 MR GARNHAM: How do you think the marks that are seen on
9 Victoria's back and buttocks might be caused? Were they
10 within reach of her hands?
11 DR AJAYE-OBE: No.
12 MR GARNHAM: Could she not have reached her buttocks if she
13 had stretched round with one hand behind her back?
14 DR AJAYE-OBE: Her buttocks yes, but maybe not her back.
15 MR GARNHAM: Thank you. Could any of these scars, in your
16 opinion, have been caused by infected insect bites of
17 some sort?
18 DR AJAYE-OBE: The hands?
19 MR GARNHAM: The hands could be?
20 DR AJAYE-OBE: No, I did not hear what you --
21 MR GARNHAM: Could any of the marks on Victoria's body,
22 hands, arms, back, wherever, have been the result of
23 infected insect bites?
24 DR AJAYE-OBE: Some could have, but I would not say all.
25 MR GARNHAM: Thank you. You have seen scabies before, you
36
1 have told us. Did this look like scabies to you?
2 DR AJAYE-OBE: It did not cross my mind that it was scabies.
3 MR GARNHAM: It did not cross your mind?
4 DR AJAYE-OBE: No.
5 MR GARNHAM: Your initial diagnosis, based -- I am sorry,
6 before I do that, let me ask you one other question.
7 What was your initial diagnosis of the injuries on
8 this little girl?
9 DR AJAYE-OBE: Non-accidental injury.
10 MR GARNHAM: You say that now confidently; were you
11 confident of it at the time?
12 DR AJAYE-OBE: I had a strong suspicion.
13 MR GARNHAM: And the basis of that diagnosis; can you
14 itemise it for us?
15 DR AJAYE-OBE: The injuries that she presented with, the
16 history. That was basically it.
17 MR GARNHAM: Did you have any concern about how she was
18 being cared for, aside from the injuries?
19 DR AJAYE-OBE: Well the fact that a neighbour brought her
20 in.
21 MR GARNHAM: Yes. What about the fact that she smelt so
22 noticeably?
23 DR AJAYE-OBE: Definitely that was one of the -- I mean, the
24 clothes themselves.
25 MR GARNHAM: Victoria's explanation was that she had done
37
1 this to herself by scratching.
2 DR AJAYE-OBE: Yes.
3 MR GARNHAM: Did you regard that as credible?
4 DR AJAYE-OBE: No.
5 MR GARNHAM: Your treatment plan, I think, was to admit her.
6 DR AJAYE-OBE: Yes.
7 MR GARNHAM: Did you reach that view on your own initiative,
8 or were you told to admit her by someone else?
9 DR AJAYE-OBE: It was on my own initiative.
10 MR GARNHAM: Secondly, to discuss with the consultant.
11 DR AJAYE-OBE: Yes.
12 MR GARNHAM: Thirdly, to arrange for blood tests to be
13 taken.
14 DR AJAYE-OBE: Yes.
15 MR GARNHAM: Did you do that?
16 DR AJAYE-OBE: Yes, I arranged, but I did not do it myself.
17 MR GARNHAM: But you asked that they be done?
18 DR AJAYE-OBE: Yes.
19 MR GARNHAM: To contact a social worker?
20 DR AJAYE-OBE: Yes.
21 MR GARNHAM: Did you know to do that or did you have to be
22 told?
23 DR AJAYE-OBE: I knew to do that.
24 MR GARNHAM: So did the decision to contact a social worker
25 come of your own initiative, or because somebody else
38
1 told you?
2 DR AJAYE-OBE: It came because I decided to do it.
3 MR GARNHAM: And fifth and finally, as part of your
4 treatment plan, skin swabs?
5 DR AJAYE-OBE: Yes, I cannot remember if I did skin swabs or
6 not. I cannot remember.
7 MR GARNHAM: What other tests were ordered by you, if any?
8 DR AJAYE-OBE: I did not order any other ones that I can
9 remember.
10 MR GARNHAM: What was the reason for the blood test?
11 DR AJAYE-OBE: We are aware in medicine that bruises can
12 come as a result of some clotting disturbances, so
13 I definitely wanted to get her clotting done.
14 MR GARNHAM: Did you contact the social worker?
15 DR AJAYE-OBE: Yes.
16 MR GARNHAM: Do you remember the name of the social worker?
17 DR AJAYE-OBE: No, I do not remember the name.
18 MR GARNHAM: What passed between you?
19 DR AJAYE-OBE: I told her that I had a child on the ward who
20 I suspected had non-accidental injury. My normal form
21 would be to give them the name and the age, and
22 I presume she did ask for a GP's name, but I did not
23 have that.
24 MR GARNHAM: You are now speaking of what would have
25 happened, you do not have a recollection now of what did
39
1 happen?
2 DR AJAYE-OBE: No.
3 MR GARNHAM: The consultant with whom you discussed this
4 case was Dr Schwartz?
5 DR AJAYE-OBE: Yes.
6 MR GARNHAM: When you spoke to her, do you remember what you
7 said?
8 DR AJAYE-OBE: I told her I had a child on the ward.
9 MR GARNHAM: Did you tell her the child's name?
10 DR AJAYE-OBE: I would have told her the child's name, yes.
11 MR GARNHAM: First name and surname?
12 DR AJAYE-OBE: Yes.
13 MR GARNHAM: What else did you tell her?
14 DR AJAYE-OBE: I would have told her that she was seven, but
15 I was not too sure of her date of birth, and that
16 I would like her to -- I would probably have given her a
17 running commentary of what this child had.
18 MR GARNHAM: Did you tell her your concerns?
19 DR AJAYE-OBE: Yes, I would have told her that I thought she
20 had NAI.
21 MR GARNHAM: That was a conversation that took place over
22 the telephone or face-to-face?
23 DR AJAYE-OBE: Telephone.
24 MR GARNHAM: Did you ever talk to Dr Schwartz face-to-face
25 about this child?
40
1 DR AJAYE-OBE: No.
2 MR GARNHAM: Did you have any other telephone conversation
3 with her, apart from that first one?
4 DR AJAYE-OBE: No, not that I remember.
5 MR GARNHAM: Did she ever get back in contact with you by
6 any other means?
7 DR AJAYE-OBE: No, she told me on that first one that she
8 would come along when she had finished, when she was
9 free.
10 MR GARNHAM: Thank you. Did you explain the basis for your
11 belief that this was non-accidental injury?
12 DR AJAYE-OBE: Yes.
13 MR GARNHAM: Did you tell her the same things as you have
14 told me?
15 DR AJAYE-OBE: I would have told her, "She has got multiple
16 bruises, multiple injuries".
17 MR GARNHAM: Did you talk about the concerns that were
18 raised by the history?
19 DR AJAYE-OBE: I told her she does not have a GP and a carer
20 brought her in.
21 MR GARNHAM: Did you say anything else about her history?
22 DR AJAYE-OBE: No.
23 MR GARNHAM: She would have been reliant otherwise on your
24 notes?
25 DR AJAYE-OBE: Yes.
41
1 MR GARNHAM: In the ordinary course, would Dr Schwartz have
2 seen your notes?
3 DR AJAYE-OBE: Yes.
4 MR GARNHAM: Did you subsequently learn that Dr Schwartz's
5 diagnosis was scabies?
6 DR AJAYE-OBE: Eventually yes I did, much later on.
7 MR GARNHAM: Do you mean weeks?
8 DR AJAYE-OBE: I think it probably was the last day, just
9 before I was leaving. I had moved to the neonatal unit,
10 I was not working on the wards.
11 MR GARNHAM: Can you tell us when that was?
12 DR AJAYE-OBE: I cannot remember.
13 MR GARNHAM: Are we talking days, weeks, months?
14 DR AJAYE-OBE: Days.
15 MR GARNHAM: Were you surprised to hear Schwartz's diagnosis
16 was scabies?
17 DR AJAYE-OBE: I was surprised, I mean, but --
18 MR GARNHAM: But she is the consultant.
19 DR AJAYE-OBE: Well, I mean, it was not so much I was
20 surprised, but the way she had actually mapped it all
21 out, she had mapped it out, so everything was in place
22 anyway, so it was like -- perhaps that I am -- I mean,
23 she is a consultant. She knows --
24 MR GARNHAM: Yes.
25 DR AJAYE-OBE: It could have been -- scabies would fit in
42
1 with part of the history. It could have been.
2 MR GARNHAM: Scabies would fit in with part of the history.
3 Were you surprised to hear that Victoria had been
4 discharged home?
5 DR AJAYE-OBE: I did not know -- yes. I knew she was
6 discharged under the social workers.
7 MR GARNHAM: You did not know she was discharged home?
8 DR AJAYE-OBE: No, I was not aware of that.
9 MR GARNHAM: If you disagree with a consultant, what do you
10 do?
11 DR AJAYE-OBE: Well I would probably talk to her or talk
12 to~...
13 MR GARNHAM: So if you heard of a consultant making
14 a diagnosis in a case that had been in your care and you
15 disagreed, you would talk to that consultant?
16 DR AJAYE-OBE: Yes.
17 MR GARNHAM: Did you talk to Dr Schwartz on this occasion?
18 DR AJAYE-OBE: I did not talk to her, no.
19 MR GARNHAM: Did you at any time during your time at CMH
20 ever disagree with a consultant?
21 DR AJAYE-OBE: No.
22 MR GARNHAM: Have you ever done?
23 DR AJAYE-OBE: There have been times now.
24 MR GARNHAM: And is that what you have done in consequence,
25 spoken to that consultant?
43
1 DR AJAYE-OBE: I would view my opinion.
2 MR GARNHAM: Can I ask you to have a look at volume 40,
3 please? At 237.502, those are Child Protection
4 Guidelines for this hospital. First of all, have you
5 ever seen them before?
6 DR AJAYE-OBE: Not for Central Middlesex, but I have seen
7 them for other hospitals.
8 MR GARNHAM: Is this a common page? Is this seen in other
9 hospital procedures?
10 DR AJAYE-OBE: Yes, I think so.
11 MR GARNHAM: The page I have got you to look at is 502. If
12 you go over to the next page to 503, 502 is concerned
13 with child in need; 503 is concerned with strong
14 concern/suspicion of abuse. If you trace it down on the
15 left-hand side, it says:
16 "Skin lesion e.g. burns, bruises (multiple different
17 ages unusual configuration site)."
18 Do you have that? Do you have 40/237.503?
19 DR AJAYE-OBE: Yes.
20 MR GARNHAM: Do you see where I am referring to?
21 DR AJAYE-OBE: Yes.
22 MR GARNHAM: "Skin lesions e.g. burns, bruises (multiple
23 different ages unusual configuration site)"; would that
24 fit this case?
25 DR AJAYE-OBE: Yes.
44
1 MR GARNHAM: That directs you to suspect abuse, which you
2 did, and that directs you to call paediatric
3 registrar/consultant, not locum.
4 DR AJAYE-OBE: Yes.
5 MR GARNHAM: Is that a common direction?
6 DR AJAYE-OBE: In Central Middlesex maybe; perhaps not in
7 other hospitals.
8 MR GARNHAM: But not in other hospitals?
9 DR AJAYE-OBE: For me, in my own experience, it does not
10 fit. If you think of it after 4.00, you have locum
11 registrars and you are the only one.
12 MR GARNHAM: So there is not much choice, really?
13 DR AJAYE-OBE: There is not much choice, no. That day,
14 I was the only one on the wards.
15 MR GARNHAM: It is conceivable the words "not locum"
16 qualifies consultant rather than registrar, but there we
17 are. In any event, you were the one who suspected abuse
18 and therefore registrar action thereafter would appear
19 to apply to you.
20 DR AJAYE-OBE: Yes.
21 MR GARNHAM: And I think if we look through that, you took
22 those steps, did you not?
23 DR AJAYE-OBE: Yes.
24 MR GARNHAM: At the very bottom, it says:
25 "NB, examination must be done by specially trained
45
1 doctors. Consider whether forensic medical examiner
2 required."
3 Did you consider that?
4 DR AJAYE-OBE: Well, I informed the consultant. I am not
5 specialised in child protection.
6 MR GARNHAM: Thank you. Can I just make sure that we have
7 got the paperwork correctly understood? You have shown
8 us the ward clerking sheets at 37/024. There is also
9 a document called the Paediatric Unitary Assessment
10 Record at 37/022; could you just look at that? What is
11 that, please?
12 DR AJAYE-OBE: That is a Paediatric Unitary Assessment
13 Record.
14 MR GARNHAM: What does that mean?
15 DR AJAYE-OBE: It is a form that you fill in.
16 MR GARNHAM: And did you fill that in?
17 DR AJAYE-OBE: Yes, I filled in what --
18 MR GARNHAM: What you could. "General Practitioner" is left
19 blank, as is "health visitor/school nurse".
20 DR AJAYE-OBE: Yes.
21 MR GARNHAM: 37/020, can you tell us what that is, please?
22 It is headed "Medical report on a child thought to have
23 suffered abuse".
24 DR AJAYE-OBE: Yes.
25 MR GARNHAM: Is that the child protection form, or is that
46
1 a different document? Let me approach that from
2 a different angle. What is the document that we are
3 looking at now?
4 DR AJAYE-OBE: It was a report -- it was a document you
5 wanted to fill in if you suspected the child had child
6 abuse.
7 MR GARNHAM: Did you fill it in?
8 DR AJAYE-OBE: Yes.
9 MR GARNHAM: Is this the child protection form?
10 DR AJAYE-OBE: I presume so, yes. It was part of the -- it
11 was attached to the body chart, so yes.
12 MR GARNHAM: The third section is headed:
13 "Physical examination. To include a description of
14 all injuries and scars which must also be illustrated
15 overleaf."
16 DR AJAYE-OBE: Yes.
17 MR GARNHAM: You then I think say:
18 "Scars of various sizes and ages all over body from
19 about two days to" -- what is the next word?
20 DR AJAYE-OBE: "... two days to several weeks, possibly
21 months. Noted fresh scars on the face, corners of
22 mouth. Infected cuts on the hands and fingers,
23 bloodshot eyes, medial conjunctiva."
24 MR GARNHAM: And then under "Action Taken", "Admit into
25 wards; to inform social workers"?
47
1 DR AJAYE-OBE: Yes.
2 MR GARNHAM: And you have signed that?
3 DR AJAYE-OBE: Yes.
4 MR GARNHAM: There is not actually any reference to bruising
5 in that physical examination.
6 DR AJAYE-OBE: No.
7 MR GARNHAM: Despite the fact that you were instructed to
8 "describe all injuries"; can you tell us why that is?
9 DR AJAYE-OBE: I have no -- I cannot remember why.
10 MR GARNHAM: Finally, I want you to have a look at some
11 photographs which were taken at the NMH Hospital,
12 please; volume 37, page 212. I wonder, while the Doctor
13 is looking at those photographs, if we could have the
14 body map diagram up again, please, on the screen.
15 If you just have a look through those pictures, I am
16 not going to ask you to look at the pictures of
17 Victoria's face, Doctor. The pictures in the bundle; go
18 past the pictures of her face, please, and go to the
19 pictures of her front and her back and her arms.
20 Looking first at the photographs of her front, her chest
21 and tummy, are any of those scars scars that you saw at
22 the time of your examination of her on 14th July?
23 DR AJAYE-OBE: Tummy, no.
24 MR GARNHAM: Chest?
25 DR AJAYE-OBE: No.
48
1 MR GARNHAM: Back? There appears to be some sort of weal to
2 the right of her right shoulder and I notice on the body
3 map that is in front of you, you will see there is
4 a mark -- no, wrong side, other one -- just at the
5 junction of her arm and her back. Are we looking at the
6 same injury?
7 DR AJAYE-OBE: I cannot remember.
8 MR GARNHAM: Flick through the next photographs; are there
9 any scars there that tally with the ones that we have,
10 in these photographs? Can we go back to the full
11 picture of the body maps, please? Any others that
12 tally? If you look at the photograph of Victoria's
13 right arm, there would appear to be a mark just above
14 the elbow, the inside of the elbow, and if you look at
15 the photograph of her front, there appears to be
16 a number of marks which look as if they are in the same
17 sort of position. Are these similar?
18 DR AJAYE-OBE: I cannot remember.
19 MR GARNHAM: You cannot remember?
20 DR AJAYE-OBE: No.
21 MR GARNHAM: Finally, on that same photograph, you will see
22 a weal-like mark beneath and to the right of Victoria's
23 right nipple; do you see that in the photographs first
24 of all? It is a photograph that is taken primarily of
25 her right shoulder.
49
1 DR AJAYE-OBE: Okay.
2 MR GARNHAM: Do you see the weal below her nipple?
3 DR AJAYE-OBE: Yes.
4 MR GARNHAM: Was that one that was present at the time you
5 saw her?
6 DR AJAYE-OBE: I did not chart it, so I do not think so, no.
7 MR GARNHAM: Thank you very much. So would it be fair to
8 say that certainly the majority of the wounds we see in
9 the photographs were not there when you examined
10 Victoria, but there are others about which you cannot
11 comment?
12 DR AJAYE-OBE: Yes.
13 MR GARNHAM: Yes, thank you very much.
14 THE CHAIRMAN: Thank you, Mr Garnham. Mr Mason?
15 MR MASON: Thank you, sir.
16 Dr Ajayi-Obe, a few questions if I may. Firstly,
17 you said you rang and telephoned Dr Schwartz. Can you
18 now recollect what time that was approximately?
19 DR AJAYE-OBE: No, I cannot remember the time.
20 MR MASON: Would it be lunchtime, early to mid afternoon,
21 late afternoon; any idea?
22 DR AJAYE-OBE: Probably some time after lunchtime.
23 MR MASON: Okay, and would that be the same answer for the
24 phone call to Social Services?
25 DR AJAYE-OBE: I cannot remember.
50
1 MR MASON: Would they have been made at about the same time?
2 DR AJAYE-OBE: Yes.
3 MR MASON: You were asked about your concerns about
4 Victoria's smell, and you said that it had to be at
5 least 24 hours, I believe, is that correct, to have got
6 to that stage?
7 DR AJAYE-OBE: Yes. Her clothes obviously had not been
8 washed for some time.
9 MR MASON: Right. You were told that she had been with
10 Mrs Cameron since the previous day, so at least
11 24 hours, because she had been dumped with Mrs Cameron
12 the previous day.
13 DR AJAYE-OBE: She was dropped at 9.45 the night before.
14 MR MASON: So that is more than 24 hours before you saw her.
15 DR AJAYE-OBE: Less than 24 hours, 9.45 at night.
16 MR MASON: And also that Mrs Cameron had some of Victoria's
17 belongings given to her as well.
18 DR AJAYE-OBE: Yes.
19 MR MASON: So in terms of Victoria's condition and clothes
20 and aroma, would that be a concern that we would have in
21 relation to her care by Kouao or by Mrs Cameron, who had
22 been looking after her, or both?
23 DR AJAYE-OBE: She was dropped at 9.45. I do not know --
24 and she brought her first thing in the morning, so it
25 could be she did not want to alter any evidence, and
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