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Archived Transcript for 11th October 2001: Pages
151 to 200
151
1 necessary or required?
2 MS JOHNSON: Yes.
3 MR SHELDON: When you were not there, what happened then?
4 MS JOHNSON: The nurse in charge of the ward would take
5 responsibility for any action that needed to be taken.
6 MR SHELDON: And would you have any subsequent involvement?
7 MS JOHNSON: Well the notes used to be left for me so that
8 I could review them, and if I felt it necessary, I would
9 go and discuss them with the staff that had been
10 involved.
11 MR SHELDON: And presumably it would not be unusual for the
12 child to have been discharged by that stage?
13 MS JOHNSON: Well my days were spread out during the week,
14 so fairly often the child would still be there. If the
15 child spent two nights in hospital, the chances are that
16 I would see them, unless obviously perhaps Friday and
17 then I was not back until Tuesday, that was the longest
18 period I was away from the wards.
19 MR SHELDON: Did you ever consider it unsatisfactory that
20 the named nurse for child protection was a part-time
21 employee, rather than a full-time employee?
22 MS JOHNSON: I did -- we did -- I had considered that the
23 whole managerial post being three days a week, not
24 specifically just the named nurse, but that that post
25 three days a week was difficult.
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1 MR SHELDON: Because it would be fair to say presumably that
2 the most effective form of involvement in a child
3 protection case for you would have been hands-on,
4 face-to-face involvement, whilst the child was on your
5 ward?
6 MS JOHNSON: Yes.
7 MR SHELDON: And that it was not so satisfactory to try and
8 do that at arm's length, by reviewing the notes after
9 the child had possibly gone?
10 MS JOHNSON: No, but it would not be possible for the named
11 nurse to be there for 24 hours, and therefore it is
12 always necessary for another nurse to be able to adopt
13 that role, in the absence of the named nurse.
14 MR SHELDON: I agree entirely that the named nurse could not
15 be there 24 hours a day, but if it was a choice between
16 three days a week and five days a week, it should be
17 five.
18 MS JOHNSON: Five days a week would certainly be better.
19 MR SHELDON: If we could have a look at the training now,
20 not specific to you, but that the nurses on your ward
21 had, and I think the relevant paragraph in your
22 statement is paragraph 9.
23 MS JOHNSON: Yes.
24 MR SHELDON: You say at the beginning of that paragraph that
25 as far as the training of other staff in child
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1 protection issues was concerned, it was your
2 responsibility as Ward Manager to make sure that all new
3 staff were given details of ward protocols during
4 induction; is that right?
5 MS JOHNSON: Yes.
6 MR SHELDON: What do you mean by "details of ward
7 protocols"?
8 MS JOHNSON: The protocols and procedures that were
9 necessary in order to work on the ward.
10 MR SHELDON: So you had a bundle, did you, of child
11 protection --
12 MS JOHNSON: There were files.
13 MR SHELDON: I see. And did each nurse have their own copy,
14 or were they somewhere where they were communally
15 available?
16 MS JOHNSON: No, there was an accessible file. There would
17 be other files around: health and safety, infection
18 control, child protection.
19 MR SHELDON: I see, so you would specifically sit down at
20 some stage with a new nurse and explain to them various
21 protocols, one of which was child protection?
22 MS JOHNSON: Yes.
23 MR SHELDON: What was the gist of what you would tell them?
24 MS JOHNSON: I would let them see where the files were, and
25 obviously give them a very brief overview, and then they
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1 would also have allocated time during their induction
2 programme to go back and spend more time to read in
3 detail, and then they were there for constant review and
4 opportunity to utilise when needed.
5 MR SHELDON: Could you have a look at volume 40, please,
6 page 56? That is a document called "Child Protection
7 Pack"; have you seen that before?
8 MS JOHNSON: Yes.
9 MR SHELDON: If I could get you to flip through past the
10 three or four pages at the beginning which have various
11 columns on to a number of pages involving guidelines,
12 and in particular, there is a document at page 65 headed
13 "Ward Guidelines".
14 MS JOHNSON: Yes.
15 MR SHELDON: Are these the protocols and guidelines you are
16 referring to?
17 MS JOHNSON: Yes, these would have been available on the
18 ward, yes.
19 MR SHELDON: I see. So these were brought to nurses'
20 attention and a copy of them was available on the ward
21 for them to refer to as and when they needed to?
22 MS JOHNSON: Yes.
23 MR SHELDON: What are missing family alerts?
24 MS JOHNSON: When children or families who are known to be
25 at risk are deemed to have disappeared, moved area,
155
1 et cetera, we used to receive an alert to be aware to
2 look out for that particular child or family.
3 MR SHELDON: I see, so like the missing persons flyers that
4 you see sometimes, so a photo saying they were missing,
5 and then if a child came in --
6 MS JOHNSON: Just a general description, background
7 information, who to contact if you felt you had seen
8 that child or that particular family.
9 MR SHELDON: I see, thank you. Third sentence of
10 paragraph 9:
11 "Staff were also given ongoing support when they
12 were dealing with child protection matters ..."
13 MS JOHNSON: Sorry, I have lost the page.
14 MR SHELDON: It is your statement, paragraph 9, third
15 sentence:
16 "Staff were also given ongoing support when they
17 were dealing with child protection matters ..."
18 Who gave them that support?
19 MS JOHNSON: I attempted to give them that support, along
20 with Dr Schwartz or whoever else was involved with the
21 case.
22 MR SHELDON: I see, and would that -- do continue.
23 MS JOHNSON: I would discuss with them their concerns and if
24 they were going to have to write a report or attend
25 a conference, you know, I would discuss that with them,
156
1 attend or not.
2 MR SHELDON: I see, so effectively what you mean there is
3 your door was open for nurses to come in if they had
4 any concerns about child protection and they could talk
5 about it with you.
6 MS JOHNSON: Yes.
7 MR SHELDON: Moving on to post discharge case discussions,
8 what used to trigger a post discharge case discussion?
9 MS JOHNSON: Well, at the ward rounds, consultant led ward
10 rounds, we would often discuss children that had already
11 been discharged, not necessarily with child protection
12 concerns, but with other medical concerns, et cetera,
13 but if there were child protection concerns and we
14 wanted to raise them again, we could do it in that
15 forum.
16 Also, if particular children around child protection
17 had caused us concern -- I can remember other cases
18 where we had actually invited Social Services back on to
19 the ward to have post discharge discussion about how the
20 case was handled and what we could do better in the
21 future.
22 MR SHELDON: I see. How regularly did those post discharge
23 case discussions occur?
24 MS JOHNSON: Twice a week we had consultant ward rounds
25 where there was the opportunity to discuss children.
157
1 MR SHELDON: Did a post discharge case discussion ever take
2 place relating to Victoria?
3 MS JOHNSON: I raised her case very briefly at the ward
4 round on the Friday after she was discharged, which was
5 my first day back at work, so she went home on the
6 Thursday and my next day on duty was the Friday.
7 MR SHELDON: Raised it briefly with whom?
8 MS JOHNSON: With the ward round team.
9 MR SHELDON: In what context?
10 MS JOHNSON: At the end of the ward round we would sit in a
11 staff room -- the consultant on call for the week and
12 any other doctors -- and we would discuss all the
13 patients that were currently on the ward, and I remember
14 asking the question -- a question around the little girl
15 that had been in earlier in the week.
16 MR SHELDON: Was Dr Schwartz involved in that?
17 MS JOHNSON: It was her week to be on call -- I do not have
18 a clear recollection of whether she was there or not,
19 but it was her week to be on call, so I would assume she
20 was there.
21 MR SHELDON: So you all got together at the end of the ward
22 round and had a discussion about all of the children on
23 the ward?
24 MS JOHNSON: Yes, things that could not necessarily have
25 been discussed at the end of the bed.
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1 MR SHELDON: I see. And some children that had been
2 discharged during the week?
3 MS JOHNSON: Yes. Perhaps children that may have come
4 through the assessment unit and been discharged without
5 being admitted. It was a forum to raise other cases.
6 MR SHELDON: How many children are we talking about?
7 MS JOHNSON: Some weeks there would be one or two, other
8 weeks there might not be any, it would just depend.
9 MR SHELDON: Right, but Victoria was identified as
10 a particular case which required discussion?
11 MS JOHNSON: I asked a question about her, yes.
12 MR SHELDON: What did you ask?
13 MS JOHNSON: It is hard to remember specifically, but
14 I think I generally asked about the little -- something
15 around the little girl that had been on the ward earlier
16 with the child protection concerns.
17 MR SHELDON: Who did you ask?
18 MS JOHNSON: Generally to the floor.
19 MR SHELDON: What did they say?
20 MS JOHNSON: That she had been discharged, she had been seen
21 by Dr Schwartz, that a letter had gone to Social
22 Services and that her mother had taken her home.
23 MR SHELDON: You knew all that from the notes though, did
24 you not?
25 MS JOHNSON: I did, but I just wanted to reconfirm that.
159
1 MR SHELDON: Should we take it that the fact that you
2 decided to raise Victoria's case, and you say that you
3 only sometimes raised one or two or maybe none, was
4 indicative of concern that you had about that case?
5 MS JOHNSON: Concern because she had been admitted and an
6 emergency Police Protection Order had been taken out, so
7 yes.
8 MR SHELDON: So you were concerned?
9 MS JOHNSON: Yes.
10 MR SHELDON: And you were told nothing that you did not
11 already know from the notes, so were your concerns dealt
12 with?
13 MS JOHNSON: Yes, I think they were dealt with at the time.
14 I felt reassured.
15 MR SHELDON: Why should the repetition of what you already
16 knew have removed the concerns that you had at the
17 beginning of that meeting?
18 MS JOHNSON: Because nothing else was highlighted to me.
19 MR SHELDON: What would have needed to have been highlighted
20 in order for your concerns to have remained?
21 MS JOHNSON: I think if anybody else had wanted to comment
22 on any other concerns or that type of thing, I suppose.
23 MR SHELDON: I want to make sure I have understood this
24 properly. Post discharge case discussions are by no
25 means universal, nor are they particularly common. Some
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1 weeks you will only have one or two, is that right?
2 MS JOHNSON: Mm.
3 MR SHELDON: You will only seek to have one if you have
4 particular concerns about an individual child; that is
5 right, is it?
6 MS JOHNSON: Mm.
7 MR SHELDON: You chose on this occasion to have a post
8 discharge case discussion in relation to Victoria
9 because you did have concerns about that child?
10 MS JOHNSON: Mm.
11 MR SHELDON: You were told nothing during the course of that
12 case discussion which you did not already know, so where
13 did your concerns go?
14 MS JOHNSON: I cannot specifically remember if I had
15 reviewed the notes prior to that meeting or after that
16 meeting, so you are saying that I had all that
17 information before, and I cannot be certain that I did
18 have all that information before. But I just remember
19 asking the question about her to ensure that I had got
20 all the adequate information from everybody.
21 MR SHELDON: Is there any particular reason why you do not
22 mention this post discharge case discussion that dealt
23 with your concerns in your statement?
24 MS JOHNSON: No, I do not --
25 MR SHELDON: Because it is potentially quite an important
161
1 element in the story, is it not?
2 MS JOHNSON: Right.
3 MR SHELDON: Because clearly one of the main topics with
4 which you are going to have to deal is why Victoria was
5 allowed to be discharged and then not followed up after
6 the concerns that had previously been identified about
7 her. You are suggesting that one of the reasons you did
8 not seek to do either of those things is because your
9 mind had been put at rest during the course of a case
10 discussion after discharge.
11 MS JOHNSON: Mm.
12 MR SHELDON: No mention of that anywhere in your statement;
13 why is that?
14 MS JOHNSON: I do not remember being specifically asked
15 about that case discussion. I mean -- and therefore it
16 was not put in the statement.
17 MR SHELDON: You said that some case discussions involve
18 social workers and others coming on to the ward --
19 MS JOHNSON: That would be quite specific, you know, if we
20 had quite major concerns about the way something had
21 been handled.
22 MR SHELDON: For example?
23 MS JOHNSON: Well, I remember quite specifically the case of
24 a child who was taken into foster care from the ward,
25 and it caused a large amount of distress amongst staff,
162
1 so we invited Social Services to come back to discuss
2 the case and to establish why it had been done in
3 a certain way, so that was sort of different to the
4 weekly stuff that we would be doing.
5 MR SHELDON: I see, so that would only be appropriate in
6 cases of particularly grave concern, of which Victoria's
7 was not one.
8 MS JOHNSON: Not at the time it was not, no.
9 MR SHELDON: Before we come on to the specific details of
10 Victoria's time on the ward, there is just one more
11 point of organisation that I would like to get your
12 assistance on, and that is the post of Liaison Health
13 Visitor. You say in paragraph 7 of your statement that
14 there was no Paediatric Liaison Health Visitor in 1999;
15 do I take it that it is implicit in that that there was
16 one before 1999?
17 MS JOHNSON: I am not aware that there ever in my time was
18 a Liaison Health Visitor.
19 MR SHELDON: Why did you feel it significant to say that in
20 your statement?
21 MS JOHNSON: I think I was asked a direct question.
22 MR SHELDON: Do you know what Liaison Health Visitors do?
23 MS JOHNSON: I assume they liaise between the Trust and the
24 community, picking up referrals that need to be taken
25 back into the community, either via A&E or the ward.
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1 MR SHELDON: They act as a link between hospitals and the
2 community organs for following up children after their
3 discharge?
4 MS JOHNSON: Yes.
5 MR SHELDON: Who fulfilled that role in relation to children
6 on the Barnaby Bear Ward?
7 MS JOHNSON: There was not a post like that.
8 MR SHELDON: But who did the work?
9 MS JOHNSON: Sorry, I am unclear of what you are asking.
10 MR SHELDON: If a child on your ward required follow-up
11 within the community, either via a school nurse or
12 a health visitor, who would inform the school nurse or
13 the health visitor of that?
14 MS JOHNSON: A discharge letter would be sent to the
15 relevant school nurse or health visitor.
16 MR SHELDON: Was any such letter sent in relation to
17 Victoria?
18 MS JOHNSON: No.
19 MR SHELDON: Was that the sort of letter that you might
20 commonly send yourself?
21 MS JOHNSON: No.
22 MR SHELDON: Who would send it?
23 MS JOHNSON: It was normally written by the doctor and sent
24 by the discharging nurse.
25 MR SHELDON: If the case was one of child protection and the
164
1 follow-up was linked to concerns about child protection,
2 is that something that you might then get involved with?
3 MS JOHNSON: I probably would not do the discharge letter,
4 I would be more likely to have had a phone call with the
5 professional involved.
6 MR SHELDON: You looked through the notes, either before or
7 after the post discharge case discussion which you have
8 spoken about, and you saw a number of things, including
9 the letter written to a duty social worker in relation
10 to housing and social issues; is that right?
11 MS JOHNSON: Yes.
12 MR SHELDON: It might be appropriate if I just get you to
13 look at that letter, which is in volume 37, at page 43.
14 That is the letter that you saw when you reviewed the
15 notes, is it?
16 MS JOHNSON: Yes.
17 MR SHELDON: And that is the letter that you saw when you
18 reviewed the notes, is it? And that is the letter that
19 I took it, from your statement, before I knew about the
20 case discussion, that dealt with many of the concerns
21 you identified, is that right?
22 MS JOHNSON: Yes.
23 MR SHELDON: You see there that it is noted that Anna and
24 her mother are homeless. That is point 1, that Anna
25 does not attend school.
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1 MS JOHNSON: Yes.
2 MR SHELDON: And you also knew that in addition to the
3 possible concerns of non-accidental injury, there had
4 been a subsequent diagnosis of scabies.
5 MS JOHNSON: Yes.
6 MR SHELDON: Which is indicative of either a dirty or in
7 some other sense unhealthy living environment; were you
8 aware of that?
9 MS JOHNSON: Not specifically.
10 MR SHELDON: What did you think --
11 MS JOHNSON: I was aware it was an infection of the skin,
12 but I would not necessarily say -- I assume you can
13 catch it from other people by direct contact and
14 therefore your home would not necessarily need to be
15 dirty or unkempt.
16 MR SHELDON: Fair enough. Even given that, was this not
17 a paradigm case for either health visitor or school
18 nurse follow-up?
19 MS JOHNSON: She was of an age for school nurse liaison,
20 yes, but because she was not registered with a school
21 nurse, we did not have a named person to speak to. We
22 would usually discuss the children -- the young children
23 with the health visitor and school age children with the
24 school nurse.
25 MR SHELDON: Are you aware of a body called Education
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1 Welfare Service?
2 MS JOHNSON: I am now in my current post, but it was not
3 some body I was aware of at the time.
4 MR SHELDON: So it is the fact that you did not have an
5 identifiable school nurse to talk to that meant you did
6 not talk to a school nurse?
7 MS JOHNSON: That is right.
8 MR SHELDON: What about a health visitor?
9 MS JOHNSON: She was not registered with a GP, and as
10 I said, because of her age, I would not have considered
11 discussing her with a health visitor.
12 MR SHELDON: If she had been registered with a GP, and you
13 saw what you saw when you reviewed the notes, would you
14 have sought to follow up with the GP the concerns that
15 had been identified by the hospital?
16 MS JOHNSON: I would have assumed that we would have had
17 discussion with her GP, yes, either copies of letters or
18 phone calls, yes.
19 MR SHELDON: So you would have done it, or if you had not
20 done it, that would only be because you were happy that
21 it had been done?
22 MS JOHNSON: Yes.
23 MR SHELDON: And if she had had a school nurse, you would
24 have followed it up with the school nurse, would you?
25 MS JOHNSON: Yes.
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1 MR SHELDON: Same thing. Either you would have done it, or
2 if you had not done it --
3 MS JOHNSON: I would have checked that it had been done.
4 MR SHELDON: So the fact that she did not have a school
5 nurse or a GP meant that you did nothing?
6 MS JOHNSON: Well, I thought that the letter to Social
7 Services outlining the fact that she was not in school
8 partly addressed those issues, because I did not have
9 anybody else to liaise with.
10 MR SHELDON: But we have had the letter in any event; you
11 indicated before that you would have either, in
12 addition, spoken to a school nurse or a GP or both.
13 MS JOHNSON: Yes, but because we could not, I did not.
14 MR SHELDON: You remember Victoria coming on the ward some
15 time around the children's supper time, is that right,
16 about 5.30?
17 MS JOHNSON: I think so, yes.
18 MR SHELDON: Were you aware from the minute she came on the
19 ward that there were child protection concerns about
20 her?
21 MS JOHNSON: Yes. My recollection is that Mary Sexton came
22 to talk to me to let me know she was admitting the
23 child. The assessment unit is part of the ward, it is
24 all one ward area. The assessment area is just one area
25 within the ward, so she had always been in the area of
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1 the ward.
2 MR SHELDON: As named nurse for child protection, if it is
3 one of your three days on duty, if a child comes on to
4 the ward with child protection concerns, are you always
5 told about that?
6 MS JOHNSON: Yes.
7 MR SHELDON: And when you knew that a child was coming on to
8 the ward with child protection concerns, what would you
9 do?
10 MS JOHNSON: I would have reviewed the notes, and started to
11 prepare a plan.
12 MR SHELDON: Would you go and see the child commonly?
13 MS JOHNSON: Yes.
14 MR SHELDON: So you looked at the notes when Victoria came
15 on the ward, did you?
16 MS JOHNSON: Mm.
17 MR SHELDON: So you saw the history and you saw the
18 concerns?
19 MS JOHNSON: Yes.
20 MR SHELDON: Did you go and see her immediately?
21 MS JOHNSON: I cannot remember exactly which order that
22 happened in, whether I read the notes first or saw her
23 first, because my first recollection of her was she was
24 immediately outside my office door.
25 MR SHELDON: Yes, well I will come on to that incident in
169
1 just a second.
2 MS JOHNSON: So I cannot say which happened first, I am
3 afraid.
4 MR SHELDON: Did you go about preparing a plan for her care?
5 MS JOHNSON: Yes.
6 MR SHELDON: And what did that plan consist of?
7 MS JOHNSON: Well, I wanted to find out about her safety,
8 and became aware of the Police Protection Order, the
9 liaison with Social Services, and I had a phone call
10 from them, so part of the plan would be to make sure
11 that those things were in place.
12 MR SHELDON: If we can go to the communication sheet and
13 your first note, which is volume 37, page 29, that is
14 your note at the bottom of the page, is it?
15 MS JOHNSON: Yes.
16 MR SHELDON: 5.30, so round about the time that Victoria
17 would have come on to the ward. It looks as though you
18 had a phone call from Michelle Hines, is that right?
19 MS JOHNSON: Yes.
20 MR SHELDON: She told you presumably that the Police
21 Protection Order was now in place?
22 MS JOHNSON: Yes.
23 MR SHELDON: Rachel Dewar appeared to be dealing with it,
24 and there was a number there.
25 MS JOHNSON: Yes.
170
1 MR SHELDON: You were given a number to contact during the
2 night if there were any problems.
3 MS JOHNSON: Yes.
4 MR SHELDON: And Michelle Hines told you presumably that she
5 would visit the ward the following day?
6 MS JOHNSON: Yes, and I asked her for a copy of the order as
7 well.
8 MR SHELDON: And she provided you with one, did she?
9 MS JOHNSON: Yes.
10 MR SHELDON: You also note:
11 "They are attempting to inform mum and friend, Child
12 Protection Team would prefer mum not to visit this
13 evening. Must be supervised if she visits."
14 So you received this information in your office,
15 presumably?
16 MS JOHNSON: Most likely, although it could have been on the
17 ward phone.
18 MR SHELDON: You made a note of it; would you then proceed
19 to tell the nurses directly involved with Victoria's
20 care what the situation was?
21 MS JOHNSON: Yes, immediately.
22 MR SHELDON: And you did that, did you?
23 MS JOHNSON: Yes.
24 MR SHELDON: Could you have a look at page 33, while you
25 still have the file open, please, same bundle, about
171
1 four pages on? That is a nursing care plan; can you
2 help me with when that document ought to be completed?
3 MS JOHNSON: Usually the care plan is made as part of the
4 admission process, although it is then changed if
5 different problems arise during the admission, so
6 different pages, different plans would be adopted at
7 different times.
8 MR SHELDON: Is it unusual for a nursing care plan not to
9 have been completed at all for two and a half or three
10 hours after a child has come on to the ward?
11 MS JOHNSON: That would not be unusual.
12 MR SHELDON: Right. Is there any particular harm in that,
13 in your view?
14 MS JOHNSON: No, not particularly.
15 MR SHELDON: As an experienced nurse, and a ward manager,
16 are you surprised that no mention of non-accidental
17 injuries, suspicions of abuse, police protection,
18 supervised visits, social worker visit, finds its way on
19 to that nursing care plan?
20 MS JOHNSON: Yes.
21 MR SHELDON: It should, should it?
22 MS JOHNSON: It should.
23 MR SHELDON: Because presumably when a nurse comes to deal
24 with the child -- and I know there is an assigned nurse,
25 but other nurses will come and go during the course of
172
1 the night -- that is probably the first thing they will
2 look at, is it?
3 MS JOHNSON: Yes, I probably would have expected her to have
4 two plan pages, one now related to the scabies and one
5 related to the actual admission and the concerns.
6 MR SHELDON: And of course you accept presumably that it is
7 also factually incorrect, in that it says that Anna had
8 been admitted with scabies, when in fact, as you know,
9 she was admitted with suspected --
10 MS JOHNSON: Non-accidental injury.
11 MR SHELDON: You recall one specific incident on the ward
12 during which you observed Victoria. Before asking you
13 for the details of that, was that the only instance of
14 direct contact with her that you recall?
15 MS JOHNSON: Yes.
16 MR SHELDON: The incident that you do recall is a fairly
17 dramatic one, where you were aware -- the way you put it
18 in your CPS statement is being aware of a "huge
19 commotion on the ward", is that right?
20 MS JOHNSON: Yes, because it was immediately outside my
21 office door.
22 MR SHELDON: It might be helpful if you had that CPS
23 statement actually. It is in volume 46, starting at
24 page 103. About six lines down:
25 "I did not have much direct involvement with the
173
1 clinical care of Anna. I clearly recall that I was
2 working in my office when there was a huge commotion on
3 the ward. I went out to the entrance to the ward, where
4 a child was crying hysterically, and throwing herself on
5 the floor."
6 Is that still your recollection of the incident?
7 MS JOHNSON: Yes, she was crying.
8 MR SHELDON: I presume that it is not unusual to see
9 children crying when their parent or carer leaves them
10 alone in the ward overnight, but that incident sticks in
11 your memory particularly, does it?
12 MS JOHNSON: I think it sticks in my memory because it was
13 happening immediately outside my office door, and
14 because she was speaking French, which is quite an
15 unusual language for our area.
16 MR SHELDON: You say in your CPS statement that it took
17 30 minutes for her to calm down, about ten lines down:
18 "After about 30 minutes, she began to calm down.
19 I spent approximately one hour with her."
20 There is a difference, is there not, between a child
21 crying because they are upset at seeing the back of
22 their mother and a child making a huge commotion, crying
23 hysterically and taking 30 minutes to calm down? Is
24 that an event of sufficient significance to find its way
25 into the clinical notes?
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1 MS JOHNSON: Yes, I mean, reading that now, it is different
2 to how I remember it, so I think the problem is time,
3 slightly blurred --
4 MR SHELDON: Do you think the more contemporaneous CPS
5 statement is probably the more accurate?
6 MS JOHNSON: It probably is, but that is not quite how
7 I remember it now, I am afraid.
8 MR SHELDON: If we say for the sake of this question that
9 the way you describe it in your CPS statement is
10 accurate, given that you knew there were suspicions of
11 abuse of this child, is unusual and dramatic behaviour
12 like that relevant?
13 MS JOHNSON: It is relevant, but I think at the time I put
14 it into the context of her being in a strange
15 environment, just having been left by her carer, not
16 understanding what we were saying, and so I got involved
17 in dealing with her immediately.
18 MR SHELDON: Do you think that you should have put it in the
19 notes, or told Dr Schwartz about it, or both?
20 MS JOHNSON: I think on reflection, a comment about that in
21 the notes would have been reasonable, yes.
22 MR SHELDON: Reasonable or obligatory?
23 MS JOHNSON: Yes, I think it should have -- I should have
24 commented on that now.
25 MR SHELDON: During the hour you spent with her on that
175
1 occasion, trying to calm her down, I think you gave her
2 a teddy bear from your office --
3 MS JOHNSON: Yes.
4 MR SHELDON: -- did you notice any particular marks on her?
5 MS JOHNSON: I do not remember any specific marks.
6 I remember she had very dark skin and that her skin
7 appeared -- my recollection is marked, but I do not
8 remember anything specific.
9 MR SHELDON: I see, so the way you put it on page 2 of your
10 CPS statement, "I noticed a large number of markings
11 which were quite visible on her arms, although I recall
12 she generally looked marked all over" -- that is
13 accurate, is it?
14 MS JOHNSON: Yes.
15 MR SHELDON: Given that you knew there were child protection
16 concerns, did you think of conducting a slightly more
17 detailed examination of her?
18 MS JOHNSON: No, because I knew that Dr Schwartz was coming
19 to see her, and she would conduct an examination. It is
20 not appropriate to do that twice really.
21 MR SHELDON: I see. Returning briefly to your conversation
22 with Michelle Hines, were you happy with the
23 arrangements that she had apparently put in place, as
24 she explained them to you?
25 MS JOHNSON: Yes.
176
1 MR SHELDON: The Police Protection Order, the fact that she
2 was coming down to visit, the fact that they were trying
3 to trace the mother; that all seemed appropriate to you,
4 did it?
5 MS JOHNSON: Yes.
6 MR SHELDON: So you were quite happy to leave that night,
7 knowing that that was the situation, and the situation
8 was the police were informed, they had placed Victoria
9 under police protection, presumably so they could
10 investigate; Social Services were on their way, and that
11 Dr Schwartz was on her way to make an informed
12 diagnosis?
13 MS JOHNSON: Yes.
14 MR SHELDON: How strong were your suspicions at the end of
15 that phone conversation that Victoria was the subject of
16 abuse?
17 MS JOHNSON: Gosh, I think that is quite hard to answer,
18 that question.
19 MR SHELDON: Well, you have read the notes, and you have
20 seen that the carer brought this child in suspecting
21 abuse. The senior house officer in Accident & Emergency
22 had confirmed those suspicions and sent the child to
23 a paediatric registrar, who had taken a detailed history
24 and come to pretty much the same view, and decided the
25 child needed to be admitted. In addition to that, the
177
1 police thought it was sufficiently serious to put the
2 child under police protection. Social workers were
3 involved and coming to visit. You will notice that the
4 child was marked all over and behaved strangely and
5 inappropriately at one stage during the time that you
6 saw her. How strong were your suspicions that she was
7 being abused?
8 MS JOHNSON: They were fairly --
9 MR SHELDON: Sorry, I think Mr Mason has something to say.
10 MR MASON: Very briefly, if I may. The question that
11 counsel has put is a fair enough question, but if he is
12 going to put it, he needs to be very clear with this
13 witness as to what Dr Beynon and Dr Ajayi-Obe both said,
14 which was a "strong suspicion of child abuse", which is
15 somewhat different from a definite diagnosis.
16 THE CHAIRMAN: I think we all caught you point, however, Mr
17 Mason, so, Mr Sheldon?
18 MR SHELDON: Sir, I am reading the way I put it, which was
19 that the carer had brought the child in suspecting child
20 abuse. The senior house officer in Accident & Emergency
21 had shared those suspicions. The paediatric registrar
22 had come to the same view. I am not sure if any of that
23 deviates dramatically from the way in which Mr Mason put
24 it, but for the sake of clarity, it is not my intention
25 to suggest to you that the diagnosis of non-accidental
178
1 injury was firm or had been confirmed by either of those
2 clinicians.
3 What I was attempting to suggest to you was that the
4 suspicions were shared by the two doctors that had
5 examined Victoria by the time you left the ward.
6 MS JOHNSON: Yes.
7 MR SHELDON: Given that, given what you had seen, and given
8 the police and social work concern, how strong were your
9 suspicions when you left for that night?
10 MS JOHNSON: They were fairly strong suspicions.
11 MR SHELDON: So how surprised were you when you came back on
12 to the ward on the next occasion to find that the child
13 had been discharged back into the care of her mother?
14 MS JOHNSON: Sorry, how surprised?
15 MR SHELDON: How surprised.
16 MS JOHNSON: I remember being surprised, but I do not really
17 know how to measure how surprised.
18 MR SHELDON: Very surprised, mildly surprised or
19 indifferent?
20 MS JOHNSON: I was surprised. I am sorry, I do not really
21 know how to answer that any differently.
22 MR SHELDON: I think surprised is good enough.
23 MS JOHNSON: Surprised, I was surprised.
24 MR SHELDON: Because you read the notes that were left out
25 for you when you came back on duty, did you not?
179
1 MS JOHNSON: Mm.
2 MR SHELDON: So you would have seen that the social worker
3 did not come and visit as she had told you that she was
4 going to.
5 MS JOHNSON: Yes.
6 MR SHELDON: What was your reaction to that?
7 MS JOHNSON: I was -- I assumed that she had made other
8 arrangements, that she must have had a phone call with
9 somebody on the ward that morning or arranged to see
10 them elsewhere.
11 MR SHELDON: And you would also have seen from the notes,
12 because no visit was noted, that the police protection
13 had been lifted without a police officer coming to
14 visit. What was your reaction to that?
15 MS JOHNSON: I do not remember being particularly surprised
16 about that.
17 MR SHELDON: Did you think to contact either the police or
18 Michelle Hines to find out why neither her nor a police
19 officer had been to visit Victoria?
20 MS JOHNSON: I remember looking at the letter and thinking
21 that contact had been made again with Social Services,
22 and I assumed that having had the phone call and then
23 a follow-up letter, that they would continue, and
24 therefore no, I did not think to investigate it any more
25 thoroughly.
180
1 MR SHELDON: As I am sure you know, one of the matters
2 I have to put to you is that it is a matter upon which
3 you could be justifiably criticised that you failed to
4 investigate why no social worker had come to visit,
5 despite the fact that you knew one was due to come and
6 visit. What do you say to that?
7 MS JOHNSON: I think on reflection, now, in hindsight,
8 I could have made a follow-up phone call.
9 MR SHELDON: Do you think you could have done or you should
10 have done?
11 MS JOHNSON: I should have done.
12 MR SHELDON: It is also a matter I have to put to you that
13 it is justifiable to criticise you for the fact that
14 when you reviewed those notes, when you came back on to
15 the ward, you did not make sufficient enquiries to find
16 out why those child protection concerns which you were
17 aware of the previous day had apparently disappeared.
18 What would you say to that?
19 MS JOHNSON: Sorry, could you repeat that?
20 MR SHELDON: Yes, certainly. What you should have done is,
21 when you were reading those notes, investigated to find
22 out why those child protection concerns had suddenly
23 disappeared.
24 MS JOHNSON: I felt they had disappeared because Dr Schwartz
25 had seen her and removed the diagnosis of non-accidental
181
1 injury.
2 (3.00 pm)
3 MR SHELDON: So do you think you did make sufficient
4 enquiries to find out why those child protection
5 concerns had apparently evaporated?
6 MS JOHNSON: I think perhaps with hindsight, I could have
7 investigated more thoroughly, but the registrar that had
8 seen her was no longer on the ward, I do not think she
9 was there at that ward, and I could have been more
10 active in investigating.
11 MR SHELDON: Again, could or should?
12 MS JOHNSON: Should.
13 MR SHELDON: Is one of the things that you should have done
14 speak to the medical staff that had been involved in the
15 decision to discharge?
16 MS JOHNSON: Yes, but again I think one of them was a locum,
17 so I was not able to speak to her directly.
18 MR SHELDON: We have already considered the letter written
19 by Dr Dempster; it is at page 43, if you want to have
20 another look at it. That is volume 37, page 43, I am
21 sorry. The way in which you effectively put it in your
22 statement is that you were satisfied on reading this
23 letter that the concerns raised around Victoria had been
24 adequately addressed.
25 MS JOHNSON: At the time, yes.
182
1 MR SHELDON: The suggestion I am making to you is that you
2 were wrong to form that view, and that this letter was
3 inadequate to address the concerns that had been raised
4 in relation to Victoria whilst she was on your ward.
5 MS JOHNSON: I think obviously there are more issues than
6 have been put into this fax, yes.
7 MR SHELDON: Two short matters before the end. Do you agree
8 that Victoria should have had some sort of follow-up in
9 the community after she was discharged from your
10 hospital?
11 MS JOHNSON: Yes.
12 MR SHELDON: Do you feel that it is part of your role as
13 a child protection named nurse to ensure that that sort
14 of follow-up is given?
15 MS JOHNSON: Yes.
16 MR SHELDON: Would it be justifiable to criticise your
17 handling of this case on the basis that such follow-up
18 was never received?
19 MS JOHNSON: Yes.
20 MR SHELDON: The last matter, it is a short one, but I am
21 afraid I am going to need you to look at volume 40,
22 page 72. What is that form for?
23 MS JOHNSON: Well, I think that that is a St Mary's Hospital
24 child protection referral form.
25 MR SHELDON: It is not a form that is used at Central
183
1 Middlesex?
2 MS JOHNSON: No.
3 MR SHELDON: So I can take it from that that it is not
4 a form that you would expect to fill in in relation to
5 a child?
6 MS JOHNSON: No.
7 MR SHELDON: And were I to attempt to criticise you for
8 failing to do so, you would tell me that I was talking
9 complete nonsense?
10 MS JOHNSON: Yes.
11 MR SHELDON: Thank you very much. That is all I have.
12 THE CHAIRMAN: On that note, Mr Mason?
13 MR MASON: Thank you, sir. I hope I will not fall into the
14 trap that counsel has so neatly avoided.
15 MS JOHNSON: Thank you.
16 MR MASON: Ms Johnson, a few questions if I may. Perhaps
17 I will start with a technical point; you said at the
18 beginning I think that you were not employed by
19 North-West London Hospitals NHS Trust in 1999. In fact,
20 the Trust did exist by then, but, as I understand it, in
21 terms of your named nurse responsibilities, you only
22 covered the Central Middlesex/Brent area, not the whole
23 of the Trust.
24 MS JOHNSON: No, not the whole of the Trust, okay.
25 MR MASON: How long have you known Nurse Gobin?
184
1 MS JOHNSON: Since I have been employed at Central
2 Middlesex. I think I have known him all that time.
3 MR MASON: And do you feel able to express a view upon his
4 competence as a nurse?
5 MS JOHNSON: Yes.
6 MR MASON: And what is that view?
7 MS JOHNSON: I think Bob has very good clinical skills, very
8 caring.
9 MR MASON: Thank you. Moving on to the question of
10 induction, a nurse joining your ward in 1998, would she
11 have had the induction to which you have referred?
12 MS JOHNSON: Yes.
13 MR MASON: You were not here on Tuesday, but Carol Graham
14 said that she was not aware of the Child Protection Pack
15 to which you have referred. I can take you to her
16 statement if necessary, but the reference, sir, is
17 volume 5, page 103. She says she joined Barnaby Bear
18 Ward after qualifying in March 1998; are you surprised
19 that she said that she was not aware of the protocols
20 and the forms?
21 MS JOHNSON: I am surprised, yes, but I do think that
22 I might have been on maternity leave by then,
23 March 1998.
24 MR MASON: And one last question: you were asked about
25 discussing the case with the medics and Dr Schwartz. As
185
1 I understand it, you think it is likely that Dr Schwartz
2 was present at the ward round --
3 MS JOHNSON: I think it is likely.
4 MR MASON: -- on Friday the 16th?
5 MS JOHNSON: Yes, I think it is likely.
6 MR MASON: And that was the ward round at which you raised
7 the question about Victoria?
8 MS JOHNSON: That is my recollection, yes.
9 MR MASON: So you cannot remember whether Dr Schwartz said
10 anything to you on that occasion?
11 MS JOHNSON: I cannot.
12 MR MASON: If you had any concerns, continuing concerns, you
13 could have raised them with her?
14 MS JOHNSON: Oh definitely.
15 MR MASON: And you would have done?
16 MS JOHNSON: If she was not there I would have been able to
17 raise them with her at another time: page her, mobile.
18 MR MASON: And would you have done?
19 MS JOHNSON: Definitely.
20 MR MASON: Thank you, sir.
21 THE CHAIRMAN: Thank you very much indeed, Mr Mason.
22 Just a couple of very brief questions, Mrs Johnson,
23 please. First of all, when you came on duty that
24 evening, and looked at the notes that you referred to
25 earlier on, Mr Sheldon was asking you, the case notes,
186
1 the reason why Victoria was admitted to the ward --
2 MS JOHNSON: Sorry, I did not come on duty that evening.
3 I worked during the day.
4 THE CHAIRMAN: Sorry, when you were on duty, were the notes
5 of Dr Ajayi-Obe included in the notes that you read?
6 MS JOHNSON: Yes, they should have been there.
7 THE CHAIRMAN: And the only other question I want to ask is:
8 could you say whether or not you knew that the woman
9 that you took to be Victoria's mother visited the ward
10 that evening?
11 MS JOHNSON: She did not visit during the time that I was on
12 duty, no.
13 THE CHAIRMAN: Thank you very much indeed. Thank you.
14 MR SHELDON: Thank you very much, sir. I have nothing
15 further to ask. Thank you very much, Mrs Johnson.
16 (The witness withdrew)
17 MR GARNHAM: Dr Modi, please, sir. Sir, I can see you
18 glancing at the clock. Would you want to take a break
19 at this stage, sir? I think I shall probably be an hour
20 with Dr Modi, so that if you wanted a break this
21 afternoon, now might be a sensible time.
22 THE CHAIRMAN: Mr Garnham, I am conscious of the fact that
23 we have got quite a lot to get through. For people's
24 personal comfort, I suppose that I ought to agree to
25 a break, so knowing full well the limitations on toilets
187
1 in this building, perhaps I had better suggest that we
2 have a break until 3.20, but I would be glad, if I got
3 a signal that people were back a bit earlier, then we
4 could start a bit earlier.
5 (3.10 pm)
6 (A short break)
7 (3.20 pm)
8 MR GARNHAM: Sir, Dr Modi, please.
9 DR ANITA MODI (sworn)
10 MR GARNHAM: Dr Modi, good afternoon.
11 DR MODI: Good afternoon.
12 MR GARNHAM: Would you give the Inquiry your full name,
13 please?
14 DR MODI: I am Dr Anita Modi.
15 MR GARNHAM: And your current professional address?
16 DR MODI: I am working as a staff grade doctor at
17 Hammersmith Hospital.
18 MR GARNHAM: Sir, Dr Modi has made one statement for the
19 Inquiry, and it is to be found in volume 5 at page 120.
20 THE CHAIRMAN: Thank you.
21 MR GARNHAM: Dr Modi, the copy of the witness statement that
22 we all have from you refers to a CV attached, but it
23 appears it is not attached. Mr Mason, your solicitor,
24 has kindly made a copy of that available to us, and we
25 will get that distributed to the interested parties, but
188
1 because we do not have it at present, I am going to ask
2 you just one or two more questions than I might
3 otherwise, if that is okay.
4 You said a few moments ago that you are a staff
5 grade doctor; tell us what that means, please.
6 DR MODI: Staff grade doctor is a post which is
7 a non-training post, which is equivalent to a registrar
8 level.
9 MR GARNHAM: It is at what level?
10 DR MODI: Equivalent to a registrar level.
11 MR GARNHAM: I see, thank you. I think it is right,
12 Dr Modi, that you are registered both with the Indian
13 Medical Council --
14 DR MODI: Yes.
15 MR GARNHAM: -- and your CV also says you have full
16 registration with the "General"; I imagine the words
17 "Medical Council" are missing.
18 DR MODI: Yes.
19 MR GARNHAM: There is no other General that we have not
20 heard about?
21 DR MODI: No. Sorry for that.
22 MR GARNHAM: You are a member of the Royal College of
23 Physicians?
24 DR MODI: Yes.
25 MR GARNHAM: The MRCP indication we have in your list of
189
1 qualifications is followed by the letters "UK
2 Paediatrics". UK means you are a member of the Royal
3 College with which we are familiar; what does the
4 "Paediatrics" tag add?
5 DR MODI: Since 1999, it is exam of Royal College of
6 Paediatrics and Child Health. Until then, the Royal
7 College of Paediatrics did not exist separately, it was
8 the Royal College of Physicians examination.
9 MR GARNHAM: Thank you very much. I think it is right to
10 say, Doctor, that since qualification, you have spent
11 the vast majority, if not all of your time, dealing with
12 neonatology or paediatrics, is that right?
13 DR MODI: Yes.
14 MR GARNHAM: How much experience of community paediatrics
15 have you had?
16 DR MODI: When I was working as an SHO at Hillingdon
17 Hospital, we were exposed to one community clinic in
18 a week, and following that, I was working as a registrar
19 level at Central Middlesex Hospital and I did five
20 months of community paediatrics then.
21 MR GARNHAM: Thank you, but most of the rest of your
22 paediatric experience has been in acute paediatrics?
23 DR MODI: Yes.
24 MR GARNHAM: You have however something like twelve years'
25 experience post qualification in paediatrics?
190
1 DR MODI: That is correct.
2 MR GARNHAM: So you are a doctor with considerable
3 experience in this field?
4 DR MODI: That is correct.
5 MR GARNHAM: And it has become your specialism?
6 DR MODI: Yes.
7 MR GARNHAM: Your post at the Central Middlesex means
8 I think that you did rotate between hospital and
9 community based paediatrics, is that right?
10 DR MODI: That is correct.
11 MR GARNHAM: By May of 1999, you were based in the community
12 but doing on-call duties in hospitals, I think one night
13 in five?
14 DR MODI: Yes, that is correct.
15 MR GARNHAM: On 14th July, which is the day I want to ask
16 you about particularly, you had worked during the day in
17 the community?
18 DR MODI: That is correct.
19 MR GARNHAM: Can you tell us what hours you had worked that
20 day in the community?
21 DR MODI: I do not have exact recollection of the events on
22 that particular day. Normally, I would be working until
23 4.30 or 4.45.
24 MR GARNHAM: From when in the morning?
25 DR MODI: From the morning, 9.00.
191
1 MR GARNHAM: 9.00 until 4.45?
2 DR MODI: In the community.
3 MR GARNHAM: And then you go to the hospital?
4 DR MODI: Yes.
5 MR GARNHAM: Where you were on-call paediatric registrar?
6 DR MODI: From 5.00 in the evening until next morning, 9.00.
7 MR GARNHAM: So you would have worked 24 hours on the trot,
8 by the end of that shift?
9 DR MODI: Yes.
10 MR GARNHAM: And the following morning, what do you do then?
11 DR MODI: The following morning, I would go back to my
12 community work, and we used to get first on call day
13 then half day off, so my commitment would have been for
14 the following morning, until lunchtime.
15 MR GARNHAM: So that by the end of the period, you would
16 have worked something like 28 hours?
17 DR MODI: Yes.
18 MR GARNHAM: Is that with or without a break, with or
19 without sleep?
20 DR MODI: The paediatric job is quite a busy job, and the
21 Central Middlesex job has been a busy job. Getting
22 sleep is very variable, depending on how busy, how many
23 patients we see and how many emergencies we get.
24 MR GARNHAM: I am sorry, Dr Modi, I did not hear --
25 DR MODI: Very variable.
192
1 MR GARNHAM: Thank you very much. In any event, by the time
2 of the events with which we are concerned, which
3 occurred at about 8.00 in the morning, you had been on
4 duty for about 11 hours?
5 DR MODI: On-call duty, about 16 hours. 5.00 in the evening
6 until next day morning 9.00.
7 MR GARNHAM: But by 8.00 in the evening of 14th July, you
8 had been on duty since 9.00 that morning.
9 DR MODI: Yes.
10 MR GARNHAM: So you had done 11 hours, and you had another
11 17-odd hours to go?
12 DR MODI: Yes.
13 MR GARNHAM: Were you used to working those sort of hours?
14 DR MODI: Yes.
15 MR GARNHAM: Did they have any effect on you, the fact you
16 were working such long hours?
17 DR MODI: It does tire one, and without any normal natural
18 breaks -- without natural breaks, we do not get any
19 other time, and paediatrics is a busy job. It can
20 affect working, towards the end of the shift.
21 MR GARNHAM: Do you have any recollection whether on this
22 particular evening, 14th July, the length of hours you
23 had been working was affecting you? Were you feeling
24 tired?
25 DR MODI: To be honest, I cannot recall.
193
1 MR GARNHAM: You describe in paragraphs 7 to 10 of your
2 statement the training that you had received and the
3 procedures that were followed at the Central Middlesex
4 Hospital. Can I ask you to go to volume 40, page 58?
5 In order to identify this document, we had better start
6 at 56. Is that a document with which you are familiar?
7 DR MODI: Yes.
8 MR GARNHAM: Tell us what it is?
9 DR MODI: It is a Child Protection Pack which is usually
10 given to all the doctors when they join the hospital
11 Paediatric Department.
12 MR GARNHAM: And did you have one when you joined the
13 Paediatric Department at CMH?
14 DR MODI: Yes.
15 MR GARNHAM: Go to page 58, please. You will see that the
16 left hand column, under the heading "Structure",
17 includes at item 1:
18 "Interagency Child Protection Guidelines/Procedures
19 to be available in all departments which have access to
20 children."
21 Did the department in which you were working have
22 access, first of all, to Interagency Child Protection
23 Guidelines/Procedures?
24 DR MODI: These guidelines were available on the assessment
25 unit, as well as day ward.
194
1 MR GARNHAM: So the document we are currently looking at was
2 available?
3 DR MODI: Yes.
4 MR GARNHAM: Was anything else available?
5 DR MODI: All the pack did have the body map charts, the
6 referral letters, and they were all kept in an assigned
7 area.
8 MR GARNHAM: Thank you. Then at figure 2:
9 "Internal Child Protection Guidelines/Procedures
10 available in all departments."
11 Were you conscious of having two discrete documents,
12 an external and an internal pack, if you like, or did
13 you just have the one?
14 DR MODI: I cannot recall fully what exactly was -- but
15 I have seen this pack on the ward, as well as on the
16 assessment unit area.
17 MR GARNHAM: Thank you. Turn on to page 70, please. Was
18 that a page that you were familiar with?
19 DR MODI: Yes.
20 MR GARNHAM: And we see there, if we follow the flow diagram
21 on the left-hand side, that skin lesions such as
22 multiple bruises of different ages and of unusual
23 configuration or site ought to prompt suspicion of
24 abuse; is that right?
25 DR MODI: Yes.
195
1 MR GARNHAM: So should changing stories or inappropriate
2 stories.
3 DR MODI: Yes.
4 MR GARNHAM: That is in the right hand column; all familiar
5 stuff to you?
6 DR MODI: Yes.
7 MR GARNHAM: The actions which the registrar is supposed to
8 take are set out at the foot of that page. Was that
9 action that you would routinely follow in a case where
10 you suspected child abuse?
11 DR MODI: Yes.
12 MR GARNHAM: Thank you. Back to your statement, please,
13 paragraph 9; you describe Dr Schwartz's training
14 sessions. What did she teach you to look out for, in
15 cases of child abuse?
16 DR MODI: The sessions which are described in paragraph 9
17 are the teaching sessions which are jointly run between
18 Accident & Emergency Department and the Paediatric
19 Department. She would go through all different types of
20 abuse, how they are present, the history taking and when
21 to suspect these -- basically child abuse. They were
22 all discussed, and she have shown several times slides
23 and pictures as well.
24 MR GARNHAM: And what were you told were the steps you
25 should take when you suspected abuse, when you as
196
1 a clinician suspected abuse?
2 DR MODI: We all were given this Child Protection Pack with
3 the induction pack, which was gone brief -- the
4 consultant used to take us briefly at the time of
5 induction. We were supposed to read the pack at home
6 and familiarise ourselves with the protocols.
7 MR GARNHAM: Did you do so?
8 DR MODI: Yes.
9 MR GARNHAM: In paragraph 12 you describe your work during
10 the evening of 14th July 1999. How much independent
11 recollection do you have of those events?
12 DR MODI: I do not have any recollection. All my statement
13 is from seeing the notes.
14 MR GARNHAM: Thank you. I will try and bear that
15 qualification in mind as I ask you the questions, but
16 let me put a series of questions to you if I may. You
17 tell us in your statement that Dr Schwartz's assessment
18 and examination took place at 8.00 that evening.
19 DR MODI: Yes, that is what I have documented in the notes.
20 MR GARNHAM: Did you observe Dr Schwartz as she went about
21 that examination? Were you watching her as she went
22 about that examination?
23 DR MODI: I would be doing that, yes.
24 MR GARNHAM: And you say "would be" because you have no
25 independent recollection, but that is your usual
197
1 practice?
2 DR MODI: Yes.
3 MR GARNHAM: Are you able to help us with how the
4 examination was carried out, whether Dr Schwartz
5 undressed the child, for example?
6 DR MODI: I do not have recollection of this particular
7 event, but normal procedure was when the consultant was
8 seeing a patient with suspected child -- physical abuse,
9 the child would be measured, height and weight would
10 have been measured by a nurse, and the observations
11 given to us, and then Dr Schwartz would undress the
12 child, except the underclothes, the child would be --
13 all the clothes would have been removed and physical
14 examination carried out from top to toe.
15 MR GARNHAM: In this case, we know from evidence we heard
16 this morning that the paediatric registrar who first saw
17 Victoria on the Barnaby Bear Ward had measured her
18 height and her weight, and we have that recorded in some
19 charts that we saw this morning. Do you know whether
20 any other measurement of that sort was carried out
21 before Dr Schwartz's examination?
22 DR MODI: I am not aware. I cannot recollect.
23 MR GARNHAM: Do you have any recollection whether you or
24 Dr Schwartz read the notes before the examination took
25 place on that day?
198
1 DR MODI: Yes.
2 MR GARNHAM: Which of you read them?
3 DR MODI: I would have read the notes when I would have been
4 handed over by the doctor who was covering the ward
5 until 5.00.
6 MR GARNHAM: You say "would have"; that again is because you
7 do not have a recollection of it now?
8 DR MODI: Yes.
9 MR GARNHAM: The same question with respect to Dr Schwartz.
10 DR MODI: What I gather from the notes is she was familiar
11 about the situation and Anna's case, as we knew her
12 then. She would have read the notes and seen the
13 diagrams before proceeding towards an examination.
14 MR GARNHAM: Thank you. Again, you say "would have", and
15 that is deliberate, because you cannot remember.
16 DR MODI: Yes.
17 MR GARNHAM: Could you see the notes, please? They are in
18 volume 37 at page 30. We see the notes at the top of
19 the page. Do you recall how long the examination took?
20 DR MODI: I do not have any recollection or comment on how
21 long it took, the exam.
22 MR GARNHAM: So if I said half an hour, you would not be
23 able to say one way or the other?
24 DR MODI: Yes. It is not clear from my notes how long the
25 examination took place for.
199
1 MR GARNHAM: Looking at those notes now, Dr Modi, do you
2 regard them as adequate?
3 DR MODI: It is not a routine practice that if a registrar
4 has already clerked a patient, to repeat all clerking
5 notes. All the relevant positive and important negative
6 points would be documented on subsequent examinations.
7 MR GARNHAM: Do you regard those notes, in the light of what
8 had gone on before, as adequate? Are you content with
9 those?
10 DR MODI: I think except for one mistake, one correction
11 I would like to make is that I have written "no child
12 protection issues", and though I have highlighted that
13 the child was homeless and was not attending school, and
14 they themselves are child protection issues, I should
15 have mentioned there were no physical abuse issues.
16 MR GARNHAM: Thank you. You say in paragraph 14 of your
17 statement, the last sentence, what I think you have just
18 told us:
19 "If there had been any other significant injuries or
20 problems than those mentioned" -- I am sorry, that is
21 not right. This is a different point.
22 "If there had been any other significant injuries or
23 problems than those mentioned, it would certainly have
24 been my practice to record them."
25 I want to make sure I understand what that sentence
200
1 means.
2 DR MODI: If Dr Schwartz's examination -- if she would have
3 found evidence of physical abuse in any form, or the
4 marks which are suggestive of physical abuse, I would
5 have noted that in the notes. The normal practice of
6 examination in patients with physical or child abuse is
7 the person who is seeing the patient writes the report
8 and draws all the diagrams and writes their own notes.
9 The other registrar or the other doctor just highlights
10 the points which are to be carried out, or if any
11 investigations or any other follow-up needs to be
12 organised, that is commented on in the notes, but the
13 ideal practice is the person who is examining the
14 patient writes their own notes.
15 MR GARNHAM: I am not entirely sure that I understand where
16 that takes us. That means that Dr Schwartz would
17 ordinarily have written up her own notes?
18 DR MODI: Yes.
19 MR GARNHAM: And the reason that she did not write them up
20 and left it to you?
21 DR MODI: I cannot recall again exactly what happened that
22 day, why she has not written her notes, but normally,
23 she has a practice, and I have seen her doing that in
24 other cases.
25 MR GARNHAM: That would make this case different from her
|
