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Archived Transcript for 11th October 2001: Pages
201 to 251
201
1 usual practice?
2 DR MODI: I would say so.
3 MR GARNHAM: But nonetheless, you cannot remember why it was
4 that you were asked to write up her notes on this
5 occasion.
6 DR MODI: I would be writing my notes anyway.
7 MR GARNHAM: Right, but you cannot remember why it was that
8 she did not write her notes and left the task entirely
9 to you?
10 DR MODI: Yes, I cannot recollect why.
11 MR GARNHAM: Do you mean by that last sentence of
12 paragraph 14 that it would be your practice to record
13 everything that is significant?
14 DR MODI: Sorry, I did not understand the question.
15 MR GARNHAM: Look again at the last sentence of
16 paragraph 14, I am trying to make sure I have understood
17 it. One way of reading it might be that you have
18 recorded any significant injuries other than those that
19 you have recorded, which plainly cannot be your
20 intention, and I am wondering whether what you mean by
21 that is it is your practice to record everything that is
22 significant.
23 DR MODI: My colleague registrar had already drawn a picture
24 and shown all the injuries on the body map. It is not
25 a routine practice to repeat all the pictures again. If
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1 there were anything different from what she has
2 documented then that would have been noted in the notes.
3 MR GARNHAM: I see, so anything that is additional to or
4 different from what the previous registrar has recorded,
5 then that is what you would record yourself.
6 DR MODI: Yes, and that would be mentioned in Dr Schwartz's
7 notes herself as well.
8 MR GARNHAM: Let us look at the notes you made. You write
9 on page 30 of volume 37 -- tell us, "14/7/99, 8.00". Is
10 that "S/O"?
11 DR MODI: "Seen by".
12 MR GARNHAM: "To stay in tonight"?
13 DR MODI: Yes.
14 MR GARNHAM: So was the intention always that Victoria would
15 remain in the single night?
16 DR MODI: At least the plan was medically to -- the
17 admission was for concerns regarding physical abuse.
18 The plan for that night was for Victoria to stay in at
19 least for that night.
20 MR GARNHAM: Thank you. "To help with the housing problem".
21 DR MODI: Yes, I have written that.
22 MR GARNHAM: And that means what?
23 DR MODI: To help with the housing problem in from -- as
24 a doctor, we have been asked quite a few times to
25 support a letter for the --
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1 MR GARNHAM: So the first sentence is not linked to the
2 second. She is not being asked to stay in tonight in
3 order to help with the housing problem, it is that there
4 is a future intention to provide some help with the
5 housing problem by way of a letter or something.
6 DR MODI: Yes, and the other reason to write, which I am
7 mentioning retrospectively, is that she was brought by
8 a carer, her mother was not in picture then, and it was
9 a place of safety in hospital as well for her, under
10 Police Protection Order.
11 MR GARNHAM: Thank you. You remember those details, do you?
12 DR MODI: I do not remember, but this is retrospective.
13 MR GARNHAM: From looking at the notes?
14 DR MODI: Looking at the notes and listening to her.
15 MR GARNHAM: You go on, "Rash, looks like scabies".
16 DR MODI: Yes, I have written that.
17 MR GARNHAM: Is that your observation of what you see, or is
18 that you recording what Dr Schwartz says?
19 DR MODI: That I will have recorded from what Dr Schwartz's
20 opinion was.
21 MR GARNHAM: Are you able to tell us whether you looked at
22 Victoria's body and decided her condition looked like
23 scabies?
24 DR MODI: I have not personally examined her myself, but
25 I was present in the room and Dr Schwartz -- it is
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1 a teaching practice of hers that if there are any
2 injuries or anything as a learning point of view, she
3 would let the registrar or any other accompanying doctor
4 to observe the lesions, so I think I would have seen
5 those lesions.
6 MR GARNHAM: Are you here recording your own observation or
7 are you merely noting down her observation?
8 DR MODI: In this case, I think I am recording her
9 observations.
10 MR GARNHAM: Do they tally with your own, so far as you can
11 recall?
12 DR MODI: I do not have any recollection of the event.
13 MR GARNHAM: If you had thought differently from what you
14 had been told, would you have made a note of that?
15 DR MODI: Yes.
16 MR GARNHAM: Why "looks like scabies"? Why not "this is
17 scabies"?
18 DR MODI: The rash in children are -- the scabies rash can
19 be very different presentations. They are not classic
20 presentation like what we see in adults, they can be
21 generalised.
22 MR GARNHAM: So there could not be at this stage
23 a definitive diagnosis of scabies?
24 DR MODI: Though the clinical diagnosis of scabies was made,
25 I think Dr Schwartz has also mentioned the dermatology
205
1 opinion, so to confirm her diagnosis.
2 MR GARNHAM: So this is a clinical diagnosis, a provisional
3 diagnosis, that is going to be subject to some form of
4 confirmation?
5 DR MODI: Yes.
6 MR GARNHAM: Was there a differential diagnosis? Was there
7 an alternative?
8 DR MODI: I do not think in this case, no, because it has
9 not been mentioned. If it is a strong clinical
10 suggestion of diagnosis, the diagnosis has been written.
11 If there was differential diagnosis, it would have been
12 my practice to mention that in the notes.
13 MR GARNHAM: So we can assume from the fact that there is no
14 differential diagnosis put down on your notes that
15 Dr Schwartz had no differential diagnosis.
16 DR MODI: No.
17 MR GARNHAM: No you are agreeing with me or no you are
18 disagreeing with me?
19 DR MODI: No, I agree that if there was a differential
20 diagnosis, I would have put that in the notes.
21 (3.45 pm)
22 MR GARNHAM: Thank you. You say in paragraph 16 of your
23 statement, if you have it:
24 "... the scabies rash is in my experience quite
25 classical."
206
1 I am not sure I understand what that means.
2 DR MODI: The scabies rash does -- I have seen several cases
3 of scabies in India as well as in this country. The
4 scabies rash, it mainly affects the web spaces in
5 children, as well as the toe spaces, but in children,
6 the rash can be more extensive, it is not just
7 restricted to hands or feet. The trunk and the body can
8 be also involved. When it is severe form and it is
9 widespread, there will be raised lesions which are
10 extremely itchy. The itching may or may not be present
11 throughout day. It is worse when it is warm -- hot
12 weather conditions, and as well as it is more at night
13 times.
14 MR GARNHAM: I am still not quite sure that I understand
15 what the expression "the scabies rash is in my
16 experience quite classical" means.
17 DR MODI: If you look at a few patients of scabies, if you
18 see two cases, you will be able to say this is definite
19 scabies, if you see the third patient. I do not know
20 whether I am making myself clear.
21 MR GARNHAM: I think it is probably me being slow. So what
22 you are saying is scabies is well recognisable from the
23 way it presents?
24 DR MODI: Yes.
25 MR GARNHAM: You go on to say that scabies in children can
207
1 cause extreme irritation, it is very itchy.
2 DR MODI: The itching may or may not be there throughout the
3 day. It is worse when in the warm condition, as well as
4 it is worse at night times.
5 MR GARNHAM: Although the degree of itchiness varies, is
6 there always itchiness in children?
7 DR MODI: Yes.
8 MR GARNHAM: So there will always be some level of itching
9 that the child will experience, but it gets worse in the
10 warm?
11 DR MODI: Yes.
12 MR GARNHAM: And is it right that the itching caused by
13 scabies in children is such that they have the greatest
14 difficulty resisted the urge to scratch?
15 DR MODI: That is correct.
16 MR GARNHAM: You say that scabies can cause a raised
17 palpable rash and redness around the rash?
18 DR MODI: That is correct.
19 MR GARNHAM: Can you describe for us, please, how that looks
20 on dark skin, on the skin of a black child?
21 DR MODI: On the dark skin mainly what you can feel is
22 a raised rash. You cannot see the redness that
23 distinctly compared to the white skin. If the child has
24 superinfection as a result of scratching, you can see
25 the yellow crusty heads on top of the rash.
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1 MR GARNHAM: This looks significantly different, does it,
2 from bruising?
3 DR MODI: Bruising is distinct from the rash, what I am
4 describing.
5 MR GARNHAM: You would have no difficulty in distinguishing
6 on the one hand a bruise and on the other this raised
7 rash?
8 DR MODI: I would not have any difficulty in distinguishing
9 those two, no.
10 MR GARNHAM: Do you think the untrained eye, a non-doctor,
11 could confuse the two?
12 DR MODI: It is possible.
13 MR GARNHAM: Back to your notes; you say: "Hyperpigmentation
14 marks on skin". Is that what you have just described?
15 DR MODI: Yes.
16 MR GARNHAM: "Other marks on web spaces and fingers look
17 like scabies."
18 DR MODI: Yes, that is what I have written.
19 MR GARNHAM: Does that mean that the hyperpigmentation marks
20 do not look like scabies but the other marks do, or do
21 they all look like scabies?
22 DR MODI: My notes are not very clear in that sense. "The
23 rash looked like scabies", it is one full sentence.
24 "Hyperpigmentation marks on skin" is a separate
25 statement.
209
1 MR GARNHAM: So you are not saying that the
2 hyperpigmentation marks look like scabies?
3 DR MODI: No.
4 MR GARNHAM: The next line has a star beside it:
5 "Skin swabs to be done."
6 DR MODI: Yes.
7 MR GARNHAM: The star is an action point, is it?
8 DR MODI: Yes, that is correct.
9 MR GARNHAM: Directed to whom?
10 DR MODI: Skin swabs -- the time of the night we have seen
11 the child, it is a non-emergency investigation, and has
12 to be done first thing in the morning, when the labs are
13 open.
14 MR GARNHAM: So it is for the attention of whom?
15 DR MODI: For the attention of the doctors who would be
16 taking over from me the following morning.
17 MR GARNHAM: Thank you. Why were skin swabs needed?
18 DR MODI: The skin swabs were needed because the lesions --
19 my colleague had described hard yellow pigmentation,
20 yellow colouration, and to rule out superarid (?)
21 bacterial infection, which is quite common with rashes
22 with scabies.
23 MR GARNHAM: So you take a skin swab that takes away some of
24 the yellow material, that is taken away to be tested to
25 see if it has signs of infection?
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1 DR MODI: Yes.
2 MR GARNHAM: Whose job is it to ensure that that happens,
3 that the skin swabs are taken and the tests are run?
4 DR MODI: Usually the swabs are taken by the nursing staff
5 and the doctors supervise -- or doctor ensures that has
6 been done.
7 MR GARNHAM: But who should do it in Victoria's case?
8 DR MODI: That should have been done by the nurse who is
9 looking after Victoria.
10 MR GARNHAM: So the nurse should take the skin swabs the
11 next morning?
12 DR MODI: Yes.
13 MR GARNHAM: Is there a doctor who should ensure that the
14 tests are done?
15 DR MODI: Yes, the doctor writes the form, and the nurses do
16 the swab and hand it over to the doctor, and that is
17 sent to the laboratory.
18 MR GARNHAM: I think it is right that you were not going to
19 be back on this ward the following morning, so who is it
20 that these reports should be given to, who should ensure
21 that the tests are done?
22 DR MODI: The normal procedure is the SHOs are responsible
23 for the ward work and registrar supervise all the work.
24 If SHOs are busy then registrar do them themselves.
25 MR GARNHAM: Do you happen to know the names of the
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1 individuals who were responsible for this child on this
2 ward the following morning, if it was not you?
3 DR MODI: I do not have any recollection of the doctors
4 I handed over to.
5 MR GARNHAM: Back to the notes; you say:
6 "To treat for scabies if possible tonight."
7 I think that was done, and a lotion was applied.
8 DR MODI: Yes, that is correct.
9 MR GARNHAM: And then another starred point:
10 "Dermatology opinion."
11 DR MODI: That is correct.
12 MR GARNHAM: That indicates, again by means of a star, that
13 the following morning, a dermatology opinion is to be
14 obtained.
15 DR MODI: The dermatology services are not based all the
16 time at Central Middlesex Hospital, so the child has to
17 be referred, and that action had to be taken the
18 following morning.
19 MR GARNHAM: And again, is it the responsibility of the
20 nurse and the SHO, or the supervising registrar to
21 ensure that that happens?
22 DR MODI: It is the responsibility of the doctors. Nurses,
23 just in case if it slipped doctors' mind, they would
24 remind us. It is not nursing responsibility.
25 MR GARNHAM: So it is the SHO the next day?
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1 DR MODI: SHO and registrar the following day.
2 MR GARNHAM: Do you know whether these tests were carried
3 out, whether the swabs were taken, whether the
4 dermatological opinion was obtained? Do you know?
5 DR MODI: I do not know.
6 MR GARNHAM: Let us go back to the notes. Next star --
7 I think it says "no child protection issues".
8 DR MODI: I would like to correct that statement.
9 Admittedly I need to correct that, because I am myself
10 aware that homelessness and not attending school are
11 child protection issues. I should have mention "no
12 physical abuse issues", rather than "no child protection
13 issues".
14 MR GARNHAM: I am interested to understand what the starring
15 means there; you have explained it in respect of the
16 first two occasions. What is the significance of the
17 star beside that observation?
18 DR MODI: There were social concerns which need to be dealt
19 with after discussing with social worker the following
20 morning.
21 MR GARNHAM: I see. Before I come on to deal with that, can
22 you help me with this? In respect of the first two
23 stars, the skin swabs and the dermatology opinion, would
24 you expect this child to be discharged before the
25 results of those procedures were obtained?
213
1 DR MODI: There were no -- scabies itself is not a medical
2 condition where the child needs to stay in hospital, so
3 I presume that if the social issues were dealt with, the
4 child was -- if the social workers were happy for this
5 child to go back to mother's care, the child could have
6 been discharged before getting the results.
7 MR GARNHAM: So from a medical point of view, the need to
8 take skin swabs and the need for a dermatology opinion
9 would not prevent discharge.
10 DR MODI: Yes.
11 MR GARNHAM: Were you aware that Victoria was under police
12 protection that night?
13 DR MODI: Yes, I was aware -- I should have been aware.
14 MR GARNHAM: Which is it, were you or should you?
15 DR MODI: I would have been aware.
16 MR GARNHAM: And how would you have been aware?
17 DR MODI: When I did handover from the doctor who was coming
18 from the whole day, would hand over to me, she would
19 have handed over to me the case of Victoria.
20 MR GARNHAM: So again you have no recollection, but you
21 assume, in accordance with normal practice, that the
22 previous registrar would have told you that fact?
23 DR MODI: Yes.
24 MR GARNHAM: And where would she have obtained it from, that
25 information, or he?
214
1 DR MODI: She must have been told by the nursing staff.
2 MR GARNHAM: So in order for this information to reach you,
3 it is necessary for the nursing staff to tell the doctor
4 and the doctor then to tell you?
5 DR MODI: Normal procedure is if there are any child
6 protection issues, the doctor herself or himself
7 contacts the social workers. We do not get always
8 Emergency Protection Order or Police Protection Order
9 straight away. If they have been implemented, we come
10 to know when they have been requested for.
11 MR GARNHAM: I understand that; what I am interested to know
12 is the mechanics by which a doctor in your position gets
13 to know that a child is the subject of police
14 protection.
15 DR MODI: The reason I would have been told in this way,
16 because I would have come on duty at 5.00, I was not
17 there on the ward whole day, so somebody had to --
18 either the doctor who had seen the child when handed
19 over, plus the nursing staff, would tell me.
20 MR GARNHAM: Were there any plans for medical follow-up for
21 Victoria after she stayed in that night?
22 DR MODI: She did not need hospital follow-up, but GP review
23 would have been useful, to ensure that she is cured of
24 her scabies.
25 MR GARNHAM: Did you know whether she had a GP?
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1 DR MODI: I cannot recollect.
2 MR GARNHAM: What was done by you, first of all, to ensure
3 that there was that level of medical follow-up in the
4 community after Victoria was discharged? Did you do
5 anything?
6 DR MODI: I was not involved in her care after I handed over
7 at 9.00 the following morning, so I do not know.
8 MR GARNHAM: Same question; whose responsibility was it to
9 ensure that there was that level of medical follow-up?
10 DR MODI: The following morning, the registrar who was
11 covering the ward would have discussed with the social
12 worker, made a discharge plan for the child, whether the
13 child is safe to go, would have discussed this with the
14 consultant on-site or with Dr Schwartz, and the
15 discharge will have taken then.
16 MR GARNHAM: That is what should have happened.
17 DR MODI: Yes.
18 MR GARNHAM: You have read the notes.
19 DR MODI: Yes.
20 MR GARNHAM: Have you seen any sign that there was arranged
21 that level of medical follow-up in this case?
22 DR MODI: No.
23 MR GARNHAM: During the time you were involved in the care
24 of Victoria, did you have any concern about the way in
25 which her case was being managed?
216
1 DR MODI: I do not think I have any doubts, in management
2 for scabies, definitely not.
3 MR GARNHAM: Did you have any concerns about how she was
4 going to be managed in the future, after Dr Schwartz's
5 examination?
6 DR MODI: I do not understand the question clearly. In
7 regards to what?
8 MR GARNHAM: You were reliant presumably on the usual
9 systems that ought to operate on that hospital ward.
10 DR MODI: Yes.
11 MR GARNHAM: Was there anything that gave you cause to think
12 that those usual systems would not operate?
13 DR MODI: There was no reason to -- normal practice would
14 have been that, and usually -- unfortunately, in this
15 case, it has not happened. I cannot explain why.
16 MR GARNHAM: Did you discuss with Dr Schwartz whether there
17 might be some merit in arranging a referral to the
18 Community Child Health Service?
19 DR MODI: Regarding?
20 MR GARNHAM: Victoria and her care after she left your
21 hospital.
22 DR MODI: Since I was working in community, I would not have
23 any contact with Dr Schwartz until the following week
24 I would have come to do my on-call duty.
25 MR GARNHAM: During the time of examination by Dr Schwartz,
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1 was that a possibility that occurred to you?
2 DR MODI: The discharge plan was not made then. The plan
3 was to obtain swabs, find out from the social workers
4 whether the child is safe enough to go home. That is
5 what I gather from my notes. There was no discharge
6 plan made then on that night.
7 MR GARNHAM: Back to your notes again, the third star, you
8 have told us, reads:
9 "No child protection issues."
10 The word "no" appears to have been written over the
11 top of another word. Can you tell us what that is?
12 DR MODI: I do not have exact recollection why I have
13 scratched that word, but retrospective thinking,
14 I think, in my mind, I still had issues of physical
15 abuse and not child protection issues and maybe I was
16 trying to write -- I cannot explain it fully, I am
17 sorry. I do not have full recollection.
18 MR GARNHAM: Would you or would you not draw a distinction
19 between child protection issues on the one hand and
20 social issues on the other?
21 DR MODI: Homelessness and not attending school, they
22 themselves are child protection issues. Though they are
23 social issues, they still come under the umbrella of
24 child protection.
25 MR GARNHAM: You note in your statement that your
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1 observation that there were no child protection issues
2 recorded in that note was picked up in a letter sent to
3 the duty social worker the following day, was it not?
4 DR MODI: Yes.
5 MR GARNHAM: Can we look at that, 37/043? This letter was
6 written by Dr Dempster, who was a locum senior house
7 officer, by the look of it. Was she a doctor you knew?
8 DR MODI: No.
9 MR GARNHAM: She appears to have written to the duty social
10 worker from Barnaby Bear Ward the following morning,
11 does she not?
12 DR MODI: Yes.
13 MR GARNHAM: And she writes:
14 "Admitted to the ward last night with concerns re
15 possible NAI. She has however been assessed by the
16 consultant, Dr Schwartz, and it has been decided that
17 her scratch marks are all due to scabies, thus it is no
18 longer a child protection issue."
19 It looks then as if she has picked up from your
20 notes this observation about no child protection issues,
21 does it not?
22 DR MODI: Yes.
23 MR GARNHAM: So it appears -- let me put it more openly.
24 Would you agree that your observation, to the effect
25 that there were no child protection issues, appears to
219
1 have affected the way the case was managed thereafter?
2 DR MODI: I do not think the management would affect --
3 because I have highlighted the child was homeless and
4 child was not attending school, and the child protection
5 issue -- I admit that it was a mistake on my part, in
6 using inappropriate phrase.
7 MR GARNHAM: As regards that phrase, can you say why you
8 think homelessness and non-attendance at school are
9 child protection issues?
10 DR MODI: Any child who is school-going age, whether they
11 are from asylum seeker or whether they are born and
12 brought up in UK, they should be at school at the school
13 age. That is needed as part of their development, and
14 homelessness has got associated problems, with lack of
15 appropriate environment for them to -- grow in a healthy
16 environment. Both these, certainly if they are not
17 taken care of, they are child protection issues.
18 MR GARNHAM: When you say that, Dr Modi, are you expressing
19 your own opinion or are you expressing Dr Schwartz's
20 opinion?
21 DR MODI: These are Children Act issues. These are not
22 individual --
23 MR GARNHAM: But that is your view of how the Children Act
24 should be looked at?
25 DR MODI: Yes.
220
1 MR GARNHAM: Dr Schwartz tells us in her statement -- sir,
2 for your note, it is paragraph 20 -- that there were
3 marks indicative of old injuries which might well have
4 no connection with scabies. You can take that from me
5 for the time being, Dr Modi. If that is right, why do
6 you not record those observations, those observations of
7 old, non-scabies injuries?
8 DR MODI: The reason as I told you, already explained,
9 Dr Schwartz would write her own notes in detail. The
10 doctor who examines the suspected cases of physical
11 abuse would write their own notes, because the other one
12 who are looking the wounds closely.
13 MR GARNHAM: But she did not, did she?
14 DR MODI: I cannot explain why it did not happen that night.
15 MR GARNHAM: This may be important; did you think she was
16 going to write her own notes?
17 DR MODI: Normally she does write herself her own notes.
18 MR GARNHAM: When you wrote these notes, did you think,
19 "I am the only one at this examination who is writing
20 the notes", or did you think, "I am one of two people
21 who is going to write up this examination"?
22 DR MODI: I am one of the two people who would write the
23 notes. This was a ward round review which I have
24 written, which we always do during ward round. When the
25 consultant examines the patient, consultant does not
221
1 write the notes straight away. The doctor would carry
2 on the action plans in the notes, which would be carried
3 out by myself and my colleague SHO.
4 MR GARNHAM: So at the time you made these notes of the
5 examination of Victoria, you expected Dr Schwartz to
6 make up her own notes some time later?
7 DR MODI: Yes.
8 MR GARNHAM: You knew, because you have told us that you
9 read the notes, that other doctors, colleagues of yours,
10 who had examined this child, had thought that Victoria
11 might be showing non-accidental injury, signs of
12 non-accidental injuries. That being so, would not marks
13 that were not caused by scabies be of significance, so
14 that you ought to have recorded them?
15 DR MODI: Sorry, I did not get that question fully.
16 MR GARNHAM: It does not win any prizes for clarity of
17 questions. I will try again.
18 DR MODI: Sorry.
19 MR GARNHAM: Other doctors, your colleagues, had examined
20 Victoria and had thought that they had found signs of
21 non-accidental injuries.
22 DR MODI: Yes.
23 MR GARNHAM: You knew that, because you had looked at the
24 notes where they were recording those findings; yes?
25 DR MODI: Yes.
222
1 MR GARNHAM: Given that you knew that that had happened, was
2 it not important to record signs that you saw,
3 suggestive of non-accidental injuries?
4 DR MODI: As I explained to you earlier, the injury marks,
5 if they were different, I would have mentioned it in my
6 notes, but if the injury marks tally with the body map
7 that my colleague has already drawn, I would not rewrite
8 the same thing.
9 MR GARNHAM: Yes, but you are working at that moment with
10 a consultant who is telling you, "This is not
11 non-accidental injury, this is scabies".
12 DR MODI: Yes.
13 MR GARNHAM: Here you are, an experienced paediatrician, and
14 you are looking at the child's body, and you know that
15 another doctor, another registrar, had seen signs of
16 non-accidental injuries.
17 DR MODI: Yes.
18 MR GARNHAM: Was it not worth recording in your notes, in
19 those circumstances, what signs of injury there were
20 that were not scabies caused?
21 DR MODI: In retrospect, yes, I should have written that.
22 MR MASON: Sir, I do not know if it has been suggested that
23 Dr Ajayi-Obe saw different marks from those that
24 Dr Schwartz and Dr Modi saw. I think the issue is one
25 of interpretation of the same marks, and it may be that
223
1 either the witness or probably myself is getting
2 slightly confused as to what exactly has been put to
3 this witness.
4 MR GARNHAM: I will try again, sir.
5 Did you yourself see any signs on Victoria's body of
6 injuries other than those caused by scabies?
7 DR MODI: I do not have recollection of the events, and
8 I would have been present with Dr Schwartz. I would not
9 have been the prime person to look very closely at the
10 injuries. I would be relying on Dr Schwartz's findings.
11 MR GARNHAM: Dr Schwartz says that she saw signs of injuries
12 other than those caused by scabies, which is why I put
13 the question the way I did.
14 DR MODI: Right.
15 MR GARNHAM: She saw signs of injuries other than scabies
16 caused injuries.
17 DR MODI: If she would have mentioned it to me, as I have
18 explained, again and again, usually the doctor
19 themselves write the notes, so I expected that she would
20 have written in her notes, or if she wanted me to write,
21 she would have mentioned it to me to make a note of
22 that.
23 MR GARNHAM: Right. In paragraph 20 of your statement,
24 Doctor, you say that it was intended that Victoria's
25 situation would be discussed with the social workers the
224
1 following day. That was a task that would fall to the
2 SHO or the registrar who took over Victoria's care the
3 next day, was it?
4 DR MODI: Yes, it would be mainly registrar.
5 MR GARNHAM: Paragraph 21, you say that if the examination
6 had found evidence of possible physical abuse, that
7 would have been recorded both in the clinical notes and
8 on an annotated body map.
9 DR MODI: Yes, that is correct.
10 MR GARNHAM: You had seen the map prepared by Dr Obe.
11 DR MODI: Yes.
12 MR GARNHAM: If another doctor had already prepared a body
13 map like that, you would not normally repeat it, would
14 you?
15 DR MODI: Unless there are changes, I would make a note of
16 those changes, or I would use another body map, and that
17 would have been the normal practice.
18 MR GARNHAM: Did you have Dr Obe's body map to hand when
19 this examination of Victoria was being conducted?
20 DR MODI: Yes.
21 MR GARNHAM: So do I take it from the fact that you did not
22 think it necessary to do a second body map that the
23 findings that you saw were the same as Dr Obe had
24 recorded on the body map?
25 DR MODI: I again repeat, I was present with Dr Schwartz.
225
1 Dr Schwartz was the consultant who was examining the
2 child. If she would have mentioned it to me to make any
3 notes, I would have made the notes.
4 MR GARNHAM: Do you exercise no independent judgment in this
5 sort of situation? You are a paediatrician of some
6 experience.
7 DR MODI: Yes, but child protection issues are very
8 sensitive issues, and we do not involve too many doctors
9 examining the patient. We avoid repeated examination.
10 MR GARNHAM: Why is it -- I am sorry, please finish.
11 DR MODI: If my colleague registrar, who is at an equal
12 level as me, has already examined the child, there is no
13 point for me to repeat the same examination. What we
14 wanted was consultant's opinion, which Dr Schwartz was
15 doing.
16 MR GARNHAM: But you would, would you not, between you, you
17 and Dr Schwartz, you would have ensured that another
18 body map be drawn if what you were looking at was
19 different from what was recorded by Dr Obe in her body
20 map?
21 DR MODI: Yes.
22 MR GARNHAM: You go on to describe the handover of Victoria
23 the following morning.
24 DR MODI: Mm.
25 MR GARNHAM: Do you recall what impression of Victoria,
226
1 physically and emotionally, you left with the staff
2 taking over from you, and do you have no recollection?
3 DR MODI: I do not have any recollection.
4 MR GARNHAM: Whose responsibility would it have been to
5 discharge Victoria from the ward?
6 DR MODI: The responsibilities of the doctors who, after
7 discussion with the social workers, would take that
8 decision.
9 MR GARNHAM: Which doctors?
10 DR MODI: The registrar. The registrar would discuss with
11 the social worker, let the relevant consultant know
12 about the child and would discharge the child.
13 MR GARNHAM: Were you aware of the hospital's discharge
14 protocol?
15 DR MODI: Yes.
16 MR GARNHAM: Can I ask you to have a look at that, please?
17 Volume 40, page 81. The first paragraph of that
18 discharge policy requires decision to discharge to be
19 taken following a multidisciplinary discussion.
20 DR MODI: Yes.
21 MR GARNHAM: Is that what happens in practice?
22 DR MODI: Yes.
23 MR GARNHAM: And when it says "multidisciplinary", who does
24 it mean?
25 DR MODI: It depends on the child's medical health problem.
227
1 If there are social issues involved in the management of
2 the child, then that would involve a social worker.
3 MR GARNHAM: Is it a face-to-face discussion, or is this
4 done by telephone normally?
5 DR MODI: The social workers are not on-site, so it would be
6 phone to phone discussion.
7 MR GARNHAM: Do you know whether there was such
8 a multidisciplinary discussion in Victoria's case?
9 DR MODI: I am not aware. I was not involved in her
10 discharge.
11 MR GARNHAM: Paragraph 5 requires the preparation of
12 a discharge summary. Whose job is that, normally?
13 DR MODI: The discharge summary is prepared by either the
14 SHO or the registrar.
15 MR GARNHAM: Paragraph 7 requires what it calls significant
16 discharge summaries, in the case of children over school
17 age, to be passed to the school doctor and the school
18 nurse; do you see that?
19 DR MODI: Yes.
20 MR GARNHAM: Did you discover whether Victoria was at
21 school? Did you know?
22 DR MODI: I knew that she was not attending school.
23 MR GARNHAM: What is supposed to happen to comply with this
24 paragraph if the child is not at school?
25 DR MODI: If the child is not at school, then the
228
1 information would go to GP and the health visitor.
2 MR GARNHAM: Should do?
3 DR MODI: It should do, yes.
4 MR GARNHAM: Page 69 in that same volume, please. This is
5 part of the Child Protection Guidelines and deals with
6 the case of a child presenting in A&E where there is
7 a high level of concern about childcare. The final
8 instruction is that the child should only be allowed
9 home when all parties are satisfied and follow-up is
10 organised. Who are the parties in that sentence?
11 DR MODI: In this particular case, I would imagine that it
12 was just mainly social workers.
13 MR GARNHAM: And the doctors?
14 DR MODI: Yes.
15 MR GARNHAM: And the nurses?
16 DR MODI: The nurses, yes, they do contribute a role.
17 MR GARNHAM: And the registrar who would have responsibility
18 for that action would be the registrar who was on the
19 following morning, is that right?
20 DR MODI: Yes.
21 MR GARNHAM: I suspect I know the answer to this question,
22 but I will ask it to be on the safe side. Given your
23 seniority and your experience, was it not part of your
24 duty to ensure that before Victoria was discharged, the
25 dermatology opinion had been obtained, the skin swabs
229
1 had been taken and tested, and that the social care
2 arrangements had been made?
3 DR MODI: I finished my duty at the hospital at 9.00, I had
4 commitments in the community the following morning, the
5 reason I have not done myself, but I must have
6 definitely handed over to the registrar who came on duty
7 the following morning, to complete. Unfortunately, the
8 work pattern, the way we work, we cannot provide full
9 continuity of care. It has to be handed over and
10 somebody else has to do our jobs which we have not
11 finished doing that night.
12 MR GARNHAM: And frankly you had done a few hours by then,
13 had you not? You had been working for 24 hours by the
14 time the following morning came.
15 DR MODI: Yes.
16 MR GARNHAM: I cannot remember whether I have asked you
17 this, but I will ask you again to be sure: do you
18 remember who the registrar was who you handed over to?
19 DR MODI: I do not have any recollection, I am sorry.
20 MR GARNHAM: Last question, Doctor, last topic: would you
21 necessarily defer to Dr Schwartz in the matter of an
22 opinion as to diagnosis, in a case like this?
23 DR MODI: No.
24 MR GARNHAM: So you might disagree with her?
25 DR MODI: I would not disagree with her. I have seen
230
1 scabies several times, and the marks, the
2 hyperpigmentation and dark marks can be confusing with
3 physical abuse. It is a very common practice. I have
4 seen several cases of child protection issues at Central
5 Middlesex, and in my experience, I do not have any
6 doubts with Dr Schwartz's opinion of scabies.
7 MR GARNHAM: So in this case, you think Dr Schwartz was
8 right about the diagnosis?
9 DR MODI: Yes.
10 MR GARNHAM: That is helpful, but it was not quite what
11 I was asking. Would you ever disagree with the
12 diagnosis of a consultant with the experience of
13 Dr Schwartz?
14 DR MODI: Yes.
15 MR GARNHAM: Have you done so in the past?
16 DR MODI: The disagreement is discussed in a formal way.
17 When I was working at Central Middlesex, I did not have
18 any problems speaking openly with any of the
19 consultants. If I would disagree, I would mention that.
20 MR GARNHAM: So you would mention it to the consultant and
21 say, "I do not agree with you about that"?
22 DR MODI: Yes.
23 MR GARNHAM: You have told us that you agreed with
24 Dr Schwartz's opinion that this child was suffering from
25 scabies. Did you also agree or did you disagree with
231
1 her view that there was no sign of non-accidental
2 injuries as well?
3 DR MODI: Again, I have not examined the child myself fully,
4 I was accompanying Dr Schwartz, but the injuries and the
5 marks which were seen on the body map and examining --
6 standing behind Dr Schwartz and watching the patient,
7 I did not think there were any marks suggestive of
8 physical abuse.
9 MR GARNHAM: Thank you for that. Since you did not carry
10 out that examination I will not press that matter with
11 you further. Thank you very much.
12 THE CHAIRMAN: Thank you very much indeed, Mr Garnham.
13 Mr Mason, please?
14 MR MASON: Thank you, sir. Dr Modi, can we carry on where
15 Mr Garnham left off about the marks? Dr Schwartz in her
16 statement -- which is volume 5, page 135, sir,
17 paragraph 20 -- I will read the whole paragraph for you,
18 Dr Modi. If you want to look at the statement,
19 Dr Schwartz's statement, please say so and the witness
20 manager will get it for you.
21 She is talking about scabies. She also said:
22 "There were other hypopigmented and hyperpigmented
23 marks on Victoria indicative of old injuries which may
24 well have had no connection with scabies, but I found it
25 impossible to date these and they did not show
232
1 a configuration pattern due to non-accidental injuries.
2 There were no hand prints, grip marks or marks that may
3 have been inflicted by an object."
4 It was put to you by Mr Garnham that if there were
5 marks that may well be unconnected with the scabies,
6 that you should make a reference to them in your note.
7 Can I please take you to the note that you made? Do you
8 have it? It is volume 37, page 30. At line 3 of your
9 note, you have written:
10 "Rash looks like scabies", and then you say:
11 "Hyperpigmentation marks on the skin."
12 Is the second part of that line a reference to the
13 other marks that Dr Schwartz has referred to in the
14 paragraph of her statement I have just read out, or is
15 it a continuation of the reference to marks caused by
16 scabies?
17 DR MODI: My notes are not very clear in that sense, and
18 I have not described exactly where the hyperpigmentation
19 marks were seen, so I cannot comment.
20 MR MASON: Nor was Dr Schwartz in her statement. Secondly,
21 you were asked about making a note of injuries which
22 were any different from those in terms of location that
23 have been referred to by one of your predecessors, and
24 if I remember correctly, the evidence of Dr Ajayi-Obe
25 this morning was that she does not recall any marks in
233
1 the web spaces between Victoria's fingers and perhaps
2 insofar as I can tell they are not on the body map.
3 However, you have written in your note, the line below
4 the line I just referred you to, "Other marks" -- is
5 that "fanned" or just crossed out?
6 DR MODI: It is crossed through. "Other marks on web spaces
7 and fingers which look like scabies".
8 MR MASON: So you and/or Dr Schwartz have noticed marks in
9 the web spaces to which you have referred in your note?
10 DR MODI: Yes.
11 MR MASON: What is the purpose of a body map? Is it to mark
12 the location of injuries or the cause of injuries or
13 what?
14 DR MODI: Body maps are mainly for the location of injuries.
15 It is just to help -- the body map itself cannot cover
16 all the points, and we have blank paper provided along
17 with the body map to describe each and every injury and
18 their measurements.
19 MR MASON: Did you think it was necessary to draw another
20 body map to put in the marks on the web spaces that are
21 apparently not in your predecessor's body map?
22 DR MODI: Unfortunately the body map does not show the web
23 spaces. It does show picture of hand but not the web
24 spaces.
25 MR MASON: So it is not something you could easily put in?
234
1 DR MODI: No.
2 MR MASON: Carrying on with scabies, you said, I believe,
3 that children with scabies have difficulty resisting the
4 urge to scratch, I think particularly at night time or
5 when it is warm. Would you expect children to scratch
6 all the time, or intermittently, or not at all, if they
7 had scabies?
8 DR MODI: The itching varies with different individuals.
9 Some individuals can scratch all day and some
10 individuals can scratch intermittently. It is very
11 variable.
12 MR MASON: Can you help with the question of whether or not
13 Victoria was scratching herself when you saw her?
14 DR MODI: I do not have any recollection of examining and
15 seeing her.
16 MR MASON: Okay. Last question, Dr Modi. You were asked
17 about swabs and whether she should have stayed in
18 hospital until swabs were taken. If a swab is taken,
19 how long is it before you get a result?
20 DR MODI: It takes a minimum 48 hours before we get
21 a definite result.
22 MR MASON: So would there be any question of keeping
23 Victoria in hospital until the results were obtained?
24 DR MODI: Medically, no, but if there were social concerns,
25 she might have stayed.
235
1 MR MASON: Should a patient be kept in hospital because they
2 have social concerns rather than medical ones?
3 DR MODI: There have been occasions where the social
4 circumstances are not very clear, and children have
5 stayed in the ward until a place of safety is found.
6 MR MASON: So is that until Social Services are happy there
7 is somewhere for them to go?
8 DR MODI: Yes. If they are happy that the child can go back
9 to their parents then they are discharged, but if they
10 are not, until the temporary arrangements are made, the
11 child would stay in hospital.
12 MR MASON: So if you had been on duty the next day as
13 a registrar, would you have been happy to discharge
14 Victoria under the continued care of Social Services?
15 DR MODI: Medically, there were no indications for this
16 child to be in hospital.
17 MR MASON: Thank you. Thank you, sir.
18 THE CHAIRMAN: Thank you very much indeed, Mr Mason.
19 Just a couple of quick points if I may, Doctor. In
20 answer to Mr Mason's question, you said that the fingers
21 were examined, in particular the webs between the
22 fingers, and swabs were taken -- or there was the
23 recommendation that swabs were taken. If you could tell
24 me, had the swabs been taken and come back positively,
25 how would Victoria have been treated?
236
1 DR MODI: If the swabs would have been positive, Victoria
2 needed a course of antibiotics.
3 THE CHAIRMAN: Sorry, I did not mean to ask for the medical
4 comment on that, it was more who would have treated
5 Victoria?
6 DR MODI: In cases where children have GPs, we request GPs
7 to prescribe antibiotics on our hospital behalf and we
8 contact them, fax them the prescription and the GPs
9 prescribe the antibiotic.
10 In Victoria's case, I think it would have been
11 difficult, since now I know that there was no GP.
12 THE CHAIRMAN: It would indeed have been difficult, but it
13 was known already that there was no GP, was it not?
14 DR MODI: Yes, but I do not recollect the whole situation.
15 THE CHAIRMAN: If a child is admitted to a ward, query
16 potential non-accidental injury, from your experience
17 would it not be normal to try and assemble, if not the
18 whole situation, some very basic things, such as the GP?
19 DR MODI: Yes.
20 THE CHAIRMAN: So why was it not done?
21 DR MODI: I was not present at the time of discharge. The
22 discharge plan was not made the night before, so I am
23 unable to answer this question.
24 THE CHAIRMAN: No, I understand that you were not there for
25 the discharge; what I am asking you is, would reasonable
237
1 practice expect that in a situation of this kind, the
2 name of the GP would have been identified?
3 DR MODI: Yes --
4 THE CHAIRMAN: The only other question I want to ask is if
5 you could look again at the note, which is 030 --
6 Mr Mason has just referred to it. Do you have them in
7 front of you?
8 DR MODI: No. (Pause).
9 THE CHAIRMAN: The line with your third star, please.
10 Mr Garnham asked you about the crossing out and the
11 rather firm "no" on the top and asked you why that may
12 have been changed. I just want to be sure about this,
13 because sitting where I sit, it looked to me as if you
14 were slightly uncertain to give an explanation for that,
15 and I think that you said that it was probably because
16 you still had some doubts about the possibility of child
17 protection issues.
18 DR MODI: I think that I admit that the notes written in
19 that -- "no child protection issue" is incorrect. There
20 were child protection issues which I myself was aware
21 of, and I have highlighted them, that the child was
22 homeless and not at school. I cannot explain that why
23 I have crossed that out, but I myself was aware at that
24 time that the child had -- the child was in need.
25 THE CHAIRMAN: If you look under the crossing out, it looks
238
1 to me, but I would like your view, as if the word that
2 was started, but not continued, began with a Q.
3 DR MODI: To be honest, I am not sure what the word starts
4 with.
5 THE CHAIRMAN: All right. Let me put it to you then: do you
6 think there is a possibility that the actual word that
7 was started but not completed was the word "query"?
8 DR MODI: I cannot answer this question. I do not have any
9 recollection.
10 THE CHAIRMAN: Thank you very much. Thank you, Mr Garnham.
11 MR GARNHAM: Sir, thank you. Mr Mason has just raised the
12 question of whether we have readily to hand the original
13 of these notes, of which these are copies. We can go
14 and get those. I wonder whether I could ask Dr Modi to
15 wait simply here for the remaining part of the
16 afternoon, so that if necessary we can deal with that,
17 if it becomes an issue. Thank you, Dr Modi. For the
18 moment, will you take a seat again?
19 (The witness withdrew)
20 MR GARNHAM: Sir, with your permission we will take one
21 final we hope relatively short witness this afternoon,
22 Ms Tyrrell. But I am being metaphorically tugged from
23 behind, so I had better get some instructions before
24 I go further.
25 Sir, I think the easiest way to deal with this is to
239
1 deal with it openly. Both of the witnesses who we hoped
2 to deal with today would like to have their evidence
3 dealt with today. Both of them, I suspect, will take
4 a relatively short amount of time, and I am more than
5 willing to take whichever one of them would be greatest
6 inconvenienced by coming back tomorrow, but can I look
7 to their advocates for some help?
8 Sir, perhaps the thing to do is for me to ask you to
9 rise for five minutes while we sort this out.
10 THE CHAIRMAN: I am happy to rise for five minutes, if that
11 is necessary, but I just wonder whether or not we could
12 sit quietly while you --
13 MR GARNHAM: Sorry, sir, that is such a novel suggestion.
14 Yes, sir, thank you.
15 THE CHAIRMAN: Maybe that is due to the fact that for me, it
16 is a novel situation. (Pause).
17 Just whilst that is being discussed, perhaps I could
18 inform everyone else that I have just had put before
19 me -- I hope this is right, I am always very wary about
20 giving out information that I have not been able to
21 verify. I will read something to you and say that I --
22 so that nobody could accuse me of being the author of
23 this. It reads:
24 "The tube strikes tomorrow are called off.
25 Tomorrow's 24-hour London Underground drivers' strike
240
1 has been called off after a union-management agreement
2 has been reached. A second strike scheduled for next
3 Thursday has also been cancelled."
4 I hope that might be of some help.
5 Mr Garnham?
6 MR GARNHAM: Sir, with the considerable help of my friends,
7 I am now in a position to invite Miss Gibson to call
8 Miss Eminowicz.
9 THE CHAIRMAN: Thank you very much.
10 MS MARYSIA EMINOWICZ (sworn)
11 MS GIBSON: Thank you for waiting, Miss Eminowicz. If
12 I could ask you to begin by giving us your full name and
13 professional address.
14 MS EMINOWICZ: Marysia Eminowicz, Chesterfield House,
15 Park Lane, Wembley.
16 MS GIBSON: And you were the Senior Education Officer in
17 Partnerships for the Brent area at the time we are
18 dealing with?
19 MS EMINOWICZ: I was a Senior Development Officer at that
20 time, and now Partnership Officer.
21 MS GIBSON: And you mention that you are the Local Education
22 Authority's ACPC representative; was that at the time we
23 are dealing with in 1999?
24 MS EMINOWICZ: Yes, that is correct.
25 MS GIBSON: And are you still that representative?
241
1 MS EMINOWICZ: Yes, I am.
2 MS GIBSON: Do any other representatives from the Education
3 Department sit on the ACPC, apart from yourself?
4 MS EMINOWICZ: Head teachers from the primary and secondary
5 schools.
6 MS GIBSON: But there is no more senior representative than
7 you on the ACPC?
8 MS EMINOWICZ: No.
9 MS GIBSON: Perhaps you do not have experience of ACPC
10 practice in other areas, but would it not be normal for
11 someone of Assistant Director of Education level to sit
12 on the ACPC?
13 MS EMINOWICZ: I believe that I was considered to be
14 a senior enough person for the role.
15 MS GIBSON: I am not suggesting you were not, but I was just
16 asking what your experience of that was, thank you.
17 You say at paragraph 6 of your statement that any
18 child who is housed by the local authority in Brent,
19 their particular housing authority, will be in school,
20 and that checks are made to that effect. How is that
21 ensured?
22 MS EMINOWICZ: There is a strong relationship between the
23 Education Welfare Service and Housing; in fact, one of
24 the education welfare officers was an ex-housing officer
25 and as a result they have developed a system of
242
1 informing each other as to when young families and
2 children are being housed within the authority, by the
3 authority, and that is the mechanism by which they can
4 actually sort of check to see if children are in school.
5 MS GIBSON: And how soon would an education welfare officer
6 go and visit, when they learn that a child housed by
7 Brent Housing is not in education, not in school?
8 MS EMINOWICZ: I do not actually know the answer to that
9 question, but I am led to believe that it is within
10 a week.
11 MS GIBSON: Is it not part of your role to check what
12 systems are in place, to ensure that these checks are
13 made?
14 MS EMINOWICZ: Not across other units within the Education
15 Department.
16 MS GIBSON: And whose responsibility is that?
17 MS EMINOWICZ: I do not know.
18 MS GIBSON: What happens in the situation of children who
19 are placed by authorities other than Brent, so, for
20 example, in this particular case, Ealing, placing
21 a child in bed and breakfast accommodation; how is any
22 check made of whether such a child is in education?
23 MS EMINOWICZ: I have no idea.
24 MS GIBSON: And again, can you help us with whose
25 responsibility it would be to ensure that such checks
243
1 are made?
2 MS EMINOWICZ: No, I am sorry.
3 MS GIBSON: Is it not part of your role as the officer on
4 the ACPC dealing with education issues to ensure that
5 there are systems in place to make sure that all
6 children receive education?
7 MS EMINOWICZ: The responsibility of a local education
8 authority is to ensure there are sufficient places for
9 children to be educated that want it. It is the
10 responsibility of parents to actually ensure their child
11 is educated.
12 MS GIBSON: There may be situations, and we know we are
13 dealing with cases here where there are a number of
14 asylum seekers who may find it harder to access
15 education. Are there any special measures in place to
16 ensure that that takes place?
17 MS EMINOWICZ: We suspect as an authority, like I understand
18 most other authorities do, that there are children in
19 the authority that have no school place and we do not
20 actually know of. The systems in place around the
21 asylum seekers are that Social Services are involved and
22 Social Services make the linkages with Education, as do
23 Housing, as do GPs, so we have a number of sources that
24 will actually feed into Education to advise us, and that
25 is what we would rely upon.
244
1 MS GIBSON: And what guidance is in place for those
2 particular people, GPs and so on, that you have just
3 mentioned, to ensure that they are aware that they must
4 feed that information to the Education Department?
5 MS EMINOWICZ: I believe that there are protocols in place,
6 but I have never actually seen them in writing. I think
7 it is understood verbally. It is one of the areas that
8 we are looking at at the moment, at improving our
9 practice as a result.
10 MS GIBSON: Because we know certainly in Victoria's case
11 that observations were made that she was not attending
12 school, but yet this was never effectively picked up,
13 and I am just wondering if anything had been done in the
14 light of her case to ensure that the systems were
15 tightened up?
16 MS EMINOWICZ: Yes, we have certainly looked at it in the
17 context of in the hospital school, improving the process
18 there, and at the moment Admissions are looking at how
19 they can use and work more closely with the Education
20 Welfare Service to improve this practice.
21 MS GIBSON: Just turning now to the situation with the
22 hospital school at CMH, firstly at the time of
23 Victoria's case, would hospital staff be made aware that
24 a particular child was the suspected victim of abuse?
25 MS EMINOWICZ: No, I do not think so.
245
1 MS GIBSON: So there would be no reason for hospital staff,
2 in the case of a particular child, perhaps to take
3 especial note of how that child was behaving?
4 MS EMINOWICZ: Is "Council" actually referring to the
5 hospital school staff, or to the hospital staff?
6 MS GIBSON: Hospital school staff.
7 MS EMINOWICZ: Right. Hospital school staff, like all staff
8 engaged to work in education, have a responsibility to
9 follow what we all the ORR principle, which is observe,
10 record, report, and if they had occasion to see the
11 young person and believe that there was an issue of
12 abuse of some sort, then they would have
13 a responsibility under the guidance to actually do
14 something about that.
15 MS GIBSON: But they are not given any advance information
16 if a child comes in; for example, in Victoria's case,
17 that it is a suspected case of non-accidental injury, so
18 perhaps they are more vigilant than they might otherwise
19 be; do you know if that is the case or not?
20 MS EMINOWICZ: I understand that case notes are usually
21 handed over to the school staff, particularly if they
22 are going to take them into the schoolroom for a period
23 of time, to do some education with them, and at that
24 time, they should have that information, yes.
25 MS GIBSON: You say at paragraph 12 of your statement that
246
1 if a child did not attend the schoolroom, and we are
2 talking about the time of Victoria's case, that would be
3 recorded at that stage in the teacher's school diary,
4 but not in the hospital school register. That aspect
5 has been remedied since; was that in the light of
6 Victoria's case?
7 MS EMINOWICZ: Yes, the register is used for recoupment for
8 financial reasons, because the hospital school can have
9 young people from Hammersmith and Fulham and all over
10 the country attending the hospital for particular
11 medical needs, so the register, which is a legal
12 document, actually identifies those young people
13 attending the schoolroom, and that is the basis on which
14 the local education authority can actually recoup costs.
15 MS GIBSON: You say at paragraph 14 that if Victoria had
16 attended the school, it is likely that it would have
17 been noted that she was not registered at any school.
18 How would that have been picked up?
19 MS EMINOWICZ: My understanding is that the hospital itself
20 makes those enquiries as to which school the young
21 person is attending, and that would be followed through
22 by the school staff. It is a very unusual situation for
23 a primary age child not to be in or have a named school.
24 It is less unusual for secondary age pupils.
25 (4.45 pm)
247
1 MS GIBSON: It may be unusual, but what system is there in
2 place to make sure that that piece of information is
3 picked up by the hospital school and transferred on to
4 the Social Services and the Education Welfare Department
5 to ensure that the child is put into the school system?
6 MS EMINOWICZ: We have established a new protocol that will
7 cover that now.
8 MS GIBSON: And how will that protocol work?
9 MS EMINOWICZ: Each time a child comes into the hospital
10 ward then the school staff will also make enquiries as
11 to whether they have got a school place and will follow
12 up.
13 MS GIBSON: Is there actually a space or entry on the school
14 register where it is recorded which school the child
15 goes to?
16 MS EMINOWICZ: Yes, on the school register, but now it is
17 being transferred also into the diary, so that the diary
18 is now picking up on every young person that is coming
19 into the ward and getting those details.
20 MS GIBSON: And would it be fair to say that there was
21 really no good reason why such a system could not have
22 been in place at the time of Victoria's case?
23 MS EMINOWICZ: There is no good reason why there was not.
24 MS GIBSON: What would be the case in relation to -- we know
25 again Victoria registered at a school, but had to wait
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1 for a place to start in September. Is there any system
2 to record details of children waiting for school places
3 from the schools where they register?
4 MS EMINOWICZ: No, there is not. Schools have direct
5 responsibility for admissions. What is asked of them is
6 they complete particular forms and send them into the
7 Education Office, to the Admissions section, where young
8 people can be followed up, but that is entirely
9 dependent on the school actually returning those forms.
10 MS GIBSON: Does it happen generally, or is that unusual for
11 schools to return those forms?
12 MS EMINOWICZ: I think it was a fairly new system in 1999,
13 and schools did not find it very easy to actually
14 complete and follow through. There are conflicting
15 issues around it, because there is a schools information
16 management system, and they found that by using that it
17 was easier than by using the local education authority's
18 forms to send back any information.
19 MS GIBSON: And what is the position now in relation to that
20 information being recorded?
21 MS EMINOWICZ: I have been advised that Admissions is
22 looking very carefully at improving practice with the
23 Education Welfare Service regarding this.
24 MS GIBSON: Is it standard in your area for children to have
25 to wait for such a long period of time, say from
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1 registering in a school in April/May time, to have to
2 wait until September before any admission can take
3 place?
4 MS EMINOWICZ: If we are not informed of the situation, then
5 we would not be able to give any assistance. If we are
6 informed of the situation, we can actually do our best
7 to give some assistance; advise the family that there
8 are vacancies in other schools local to where they are
9 actually resident, things like that.
10 MS GIBSON: Thank you very much.
11 THE CHAIRMAN: Thank you very much --
12 MS GIBSON: Sir, I just have one document to put to this
13 witness. I wonder if the witness manager could show
14 a copy of this? I actually have a page reference, it is
15 volume 4, page 73. Can I ask you if you are familiar
16 with this form, and if you can assist us with what this
17 form is and what it is supposed to do?
18 MS EMINOWICZ: No, I am not familiar with this form. It is
19 a registration form of some sort, but I do not know in
20 which context it would be used.
21 MS GIBSON: Thank you very much. If you would wait there,
22 I do not know if the Panel have any questions.
23 THE CHAIRMAN: Mr Turner?
24 MR TURNER: No questions, thank you, sir.
25 THE CHAIRMAN: Just one moment, please. (Pause). I am sorry
250
1 about this; just one question, if I may. You said
2 earlier on, in answer to a question that Miss Gibson put
3 to you -- and it sounded rather a stark response and
4 I just wanted to make sure that I got it right. You
5 said that it is the responsibility of the local
6 education authority to provide the places in school, it
7 is the responsibility of the parent to make sure the
8 child is educated.
9 MS EMINOWICZ: Correct.
10 THE CHAIRMAN: I was wondering how that fits in with your
11 job title, which, as I understand it, is responsibility
12 for inclusive education.
13 MS EMINOWICZ: I do not know how to answer that actually.
14 Inclusive education means enabling all children who have
15 difficulties of some sort or another to actually
16 access -- but it does not mean access, actually -- an
17 education place. That is within my job description.
18 THE CHAIRMAN: Could you just say the last bit again?
19 MS EMINOWICZ: My job is to facilitate young people's access
20 to education, but it does not mean that I have to find
21 them a school place. It is once they are in a school,
22 and once they are engaged in education, that is where
23 I would come in.
24 THE CHAIRMAN: I am grateful, thank you very much,
25 Miss Gibson?
251
1 MS GIBSON: Sir, I have no more re-examination for this
2 witness. Thank you very much.
3 MS EMINOWICZ: Thank you.
4 (The witness withdrew)
5 MR GARNHAM: Sir, thank you. That completes our evidence
6 for today. The more fortunate amongst us resume again
7 at 7.30 tomorrow morning; those who take a more generous
8 attitude to their own working practices will start,
9 I would suggest, sir, at 10.00 tomorrow. We will take
10 the one witness who we did not get to today first, and
11 then we will go on with the list as published.
12 THE CHAIRMAN: Well, you have spared me, Mr Garnham, from
13 making perhaps a second novel suggestion, so thank you
14 very much indeed.
15 Ladies and gentlemen, I will not repeat what
16 Mr Garnham said, I hope that that was clear. Thank you
17 very much indeed.
18 (4.55 pm)
19 (Hearing adjourned until 10.00 am the following day)
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