GENERAL MEDICAL COUNCIL
FITNESS TO PRACTISE PANEL (PROFESSIONAL CONDUCT)
Monday 27 November 2006
44 Hallam Street, London, W1W 6JJ
Chairman: Dr Jacqueline Mitton
Panel Members:
Mrs Leora Lloyd
Mr Alexander McFarlane
Dr Sameer Sarkar
Mr Arnold Simanowitz
Legal Assessor: Mr Robin Hay
CASE OF:
SOUTHALL, David Patrick
(DAY ELEVEN)
MR RICHARD TYSON of counsel, instructed by Messrs Field Fisher Waterhouse, solicitors, appeared on behalf of the Complainants.
MR KIERAN COONAN QC and MR JOHN JOLLIFE of counsel, instructed by Messrs Hempsons, solicitors, appeared on behalf of Dr Southall, who was present.
(Transcript of the shorthand notes of T. A. Reed & Co.
Tel No: 01992 465900)
I N D E X
Page No
DAVID PATRICK SOUTHALL
Examined by MR COONAN, Continued 1
THE CHAIRMAN: Good morning everybody. Mr Coonan, I understand that there has been some minor technical difficulty, if I may put it that way.
MR COONAN: Madam, there was. I am sorry that they have bedevilled matters this morning and resulted in a late start, but both teams needed to access photocopiers and I am afraid they rather let us down. There is still some photocopying yet to take place. As far as I am concerned, there may come a point at which I will need to check that all that has been completed, so I may have to ask your indulgence a little later in the morning to see whether that has been done. I hope that does not cause too much difficulty.
MR TYSON: Madam, I share the same technical difficulties which is why I have no representative from my instructing solicitors with me, but I am quite content to carry on without that representative for present purposes.
You may remember last thing on Friday there was an issue between my learned friend and I as to the SC file relating to Child B. You kindly permitted me to take the file away. Can I clear up some misunderstandings because I may have used some overheated words, for which I apologise? Firstly, the original SC file itself was at the trust and not with Messrs Hempsons. Secondly, it was seen by those instructing me some time ago in order to see what documents were originals and what were not. Thirdly, it was seen by those instructing me on 31 October this year, when both sets of solicitors went over to the trust and learnt about computers, and at that time my instructing solicitors took possession of the file and brought it down to this hearing. Thus the only time Messrs Hempsons’ team and my learned friend’s team had the opportunity to see the original file was at the beginning of this hearing. Any suggestion that they brought it and had custody and control of it throughout, that I might have suggested, is wrong and I apologise for that.
The real problem and where the difficulties have arisen as to why the C5 file, which has the photocopy of the SC file, does not have the totality of the facts which you looked at separately is, as ever, in that both parties were provided with a photocopy of the SC file by the trust. It was not those instructing me that photocopied the SC file. They were not given access for that purpose, so we were relying on the Trust’s photocopying of the file. Clearly the trust failed to photocopy all the pages and that mistake only became clear over the weekend. I hope that has cleared the matter up. If and in so far as I made implications or suggestions against my learned friend or his team about the matter, I unreservedly withdraw them.
MR COONAN: I thank Mr Tyson for those words. Indeed it does clear the matter up and I am grateful for that. Madam, with your leave can I turn attention to the next stage of Dr Southall’s evidence. I am going to turn to Child D, which is a Stoke case, and first of all deal with the question of documentation.
DAVID PATRICK SOUTHALL
Examined by MR COONAN, Continued
MR COONAN: Dr Southall, for these purposes can you make sure that you have, first, to one side of you, Appendix One of the Notice of Hearing, and also bundle C2. If you turn in C2 to tab 4, I want, with your assistance, just to set the clinical background in context before coming to a series of questions.
These documents we have looked at at a much earlier stage of the hearing. At tab (a), Dr Rodgers is referring this child, this baby, to the dietician at Wexham Park, back in April 1989 and one notes the wording of the first sentence that we will see appears in almost exactly the same terms in subsequent letters from the GP. Is that right?
A Yes.
Q At tab (b), again a referral by Dr Rodgers to Dr Connell, a paediatrician at Wexham Park. Then a letter at tab © from Dr Connell back to Dr Rodgers, and again I do not take you to any of the content of that, simply to note it. Then at tab (d), again Dr Connell to Professor Soothill at Great Ormond Street, and then further correspondence from Dr Strobel at tab (e). Finally, for immediately contingent purposes, we go to tab (f). Is that the referral letter from Dr Rodgers, the GP, to you?
A Yes, it is.
Q What did you understand to be the underlying thrust of that letter?
A That child D had severe allergy problems, not in doubt, major issue for the child, but also a new problem or a related problem where the mother was worried about him having episodes, particularly at night during sleep, where he becomes pale and has a low body temperature. I think she was worried that he might be at risk of something happening to him. The referral was for me to investigate those episodes and possibly consider some kind of home monitor to alert her to their presence.
Q On the last line of the letter there is a reference to “PO meter”. I think Mrs D was asked about this. What is your understanding of that reference to “PO meter”?
A It is a transcutaneous oxygen monitor that measures oxygen through the skin non-invasively.
Q Which part of the body is it affixed to?
A It can be put anywhere, but generally it is on the trunk or the leg.
Q Can that monitor be taken home?
A Yes.
Q Then Child D was admitted, and the body of those notes you can see in the next tab, Tab (g). We see, first of all, on page 601 that the child was admitted on 29 November. Again, just for the record, is that your writing?
A I am not sure he was admitted then. I think that was the out-patient clinic note.
Q It is probably my mistake.
A That is not my writing; that is Dr Kildin.
Q We see his signature at the bottom right hand corner on page 605.
A Yes.
Q On page 605 there is a reference to the child being seen by you.
A Yes.
Q Do you accept that you saw the child?
A Yes. What happened was that the registrar usually saw some of the children and I always saw them afterwards, especially new patients.
Q If you drop your eye further down 605, you will see under the typescript, “investigations ordered”, the doctor has written, “For admission 12/12/;94”.
A Yes.
Q “Continuous temp recording and O2 recording”. What therefore – can you flesh this out for us – was the plan?
A The plan was for him to come in and have continuous night time, overnight tape recordings of non-invasive signals; namely, oxygen levels in the blood and skin, breathing movements, electrocardiogram, and in this case in addition he would have continuous temperature monitoring from the axilla.
Q If we move through the notes – they are slightly out of order – and go to page 604, do you have that?
A Yes.
Q Just over half-way down, Dr Suchak, SHO, appears to have made a note,
“Admit for recordings. Registrar informed of”,
and then clearly a name which is wrong.
A Yes, it is wrong.
Q Attention was drawn to that by Mrs D herself, do you remember, Dr Southall?
A Yes, I do.
MR COONAN: “Registrar informed of [name] admission”. This page is out of order. It is after page 603.
THE CHAIRMAN: After page 608, we get 603, 604 and then 609.
MR COONAN: Yes, that is right. Let us go back to that Dr Southall, “Registrar informed of [name] admission”. Is that an arrow?
A It may be, “because of”.
Q “Risk of anaphylaxis”, Dr Suchek. Then the entry at the bottom, I think we have been told that that is 13 December 1994. It is cut off certainly on my photocopy. “Review”, and then, “Discussion with Dr Samuels”. Can you just deconstruct that note for us, Dr Southall?
A Yes. Dr Samuels, as you know my colleague consultant, was notified that there had been an episode in the recording period the night before. He therefore suggested a further night’s overnight recording by the look of it, and the tape to be looked at and saved for analysis because of the event that had occurred.
Q If you go over the page, which is in fact paginated at 609, the date in the top left hand corner again is 13 December and appears to be Dr Suchak’s note as well, or can you say who it is?
A I cannot be sure. It looks like his writing.
Q No matter. Is there a note that there was a discussion with Professor Strobel at Great Ormond Street?
A Yes.
Q You will see on the next page there is a note that you carried out a ward round. Do you have a memory now of being involved in these investigations?
A Yes, I do, but it is vague, but I do have a memory of some of it, yes.
Q Taking us through up to, say 14 December – I do that because the last line of the entry on 14th, bottom of the page 609, “to discuss with Professor Southall re further plans” – so far, on 14 December, what was the analysis? What was your analysis of what was happening?
A I cannot be sure at this stage, it is 12 years ago, but I think I would have been talking to Dr Samuels who had had a bit more contact by then. I think we would be wondering whether this was some kind of allergy even that was relating to something he had eaten perhaps, or was it that mum was over worried and over anxious about something that was perhaps within the normal range of behaviour for such a child’s age.
Q If you go over the page to 610, on 15 December – I will return to deal with this occasion later but for the purposes of looking at the background here – do you accept that you did a ward round?
A It says I did so I would have done, I think.
Q Again it looks as if that is Dr Suchak’s note. I say that, if you turn over the page.
A Yes, it is.
Q The last entry on page 611 I just want to ask you about. It is the same day,
15 December, “D/W [discussed with] Prof Strobel.” Is that your signature on the bottom right-hand corner?
A Yes, it is.
Q Did you have a discussion with Professor Strobel about this?
A Yes.
Q Why did you do that?
A Because Professor Strobel had been much more involved with Child D than we had and we were getting worried about what was being reported to us and we were concerned particularly about the rectal temperatures being taken, the blood sugars that had been requested. As far as we could see, apart from his extreme allergy, which we accepted, he was a healthy boy, and I wanted to know what Professor Strobel thought.
Q As a result of, first of all, the discussion with Professor Strobel and the clinical impression that you had from his stay in hospital, did you – and I am using that in a personal sense; you, personally – come to an opinion as to what was happening with this little boy?
A Yes, I did.
Q Which was
A I accepted he has severe allergy but I thought that his mum was exaggerating his symptoms.
Q Then looking at that note, do you see at the third line, “Needs SS strategy meeting.” What does that mean?
A If we had concerns that a child might be suffering from exaggerated or fabricated illness, the first step was to hold a social services strategy meeting, with social services being the lead agency for child protection.
Q The next line:
“To invite Prof Strobel”,
and the next line, is that:
“Cons [consultant] Wexham”?
A Wexham Park Hospital. That is Slough. That is the local consultant paediatrician, who would be Dr Connell I think.
Q Dr Connell, and then in the next line what does “DS, MPS etc.” mean?
A DS is me, MPS is Martin.
Q Martin Samuels?
A Yes. “etc.”, well might be the nurses from the ward. We usually had one of the senior nurses would come to give an opinion usually.
Q And the last line, “Martin Banks contacted.” Who was he?
A Martin Banks was a senior social worker in Newcastle-under-Lyne who was very much involved with us in our work, having been involved with a number of covert video cases that we had been involved in. So, he knew about fabricated illness. I should say, by the way, that I was not thinking that this was a serious – not serious end of the spectrum. This is at the least serious end of the spectrum of this condition, which varies from exaggeration to fabrication through to induction of illness. I was not thinking about that at all. We were thinking about exaggeration.
Q Just moving on, I note in passing at tab (h) there are then nursing notes which I just identify and move finally, by way of introduction, to your medical report at tab (i). Is this your signature on the last page at 269?
A Yes, it is.
Q The report is dated 24 April 1995?
A Yes.
Q Does this report summarise, as much as stood on 24 April 1995, the events which had happened to your knowledge since your first contact with this little boy?
A Yes, they do.
Q In particular, if you turn to page 268, is there a series of notes, a series of observations in this report in relation to the ward round on 15 December?
A Yes, there is.
Q Finally, at the bottom of page 268, looking at the last sentence, was this really the high point of the admission:
“It was agreed that a Social Services strategy meeting should be established”?
A Yes, it was.
Q Dr Southall, against that background could I therefore deal with the question of the special cases file and for this you will need C6, please. (After a pause) The first question is: Do you accept that you created a special cases file for this patient?
A I did.
Q What was the reasoning for the creation of an SC file?
A All patients referred for monitoring and as tertiary referrals had a special case file.
Q Was that the reason that applied to this child when the special cases file was opened?
A Yes, it was.
Q There are a number of documents which are cited in Appendix One. You will see that in Appendix One, Dr Southall, the last item in the list is item 4, which is described as “Patient’s Data 13 December 1994” at page 313. Can you open the file at page 313? It is right at the back of the file, and page 313 is headed “Patient’s Data” and on the top left-hand corner we see a case reference number 3874. Is that the special cases file number?
A Yes, it is.
Q Was this, in its layout, a proforma document?
A Yes, it is.
Q Where is it generated from?
A The computer.
Q That is the computer in the Academic Department or the hospital computer?
A No, the Academic Department computer.
Q We see that the date of it is 13 December 1994, the top right-hand corner?
A Yes.
Q In other words, relating to the time he was admitted to hospital?
A Yes.
Q It is a fact, because you have admitted it, that this document does not appear in the main hospital medical notes.
A That is right.
Q You accept that?
A I accept that, yes.
Q But it is in the special cases file?
A Yes, it is.
Q Should this or a copy of it have been in the main file?
A It was my policy that it should have been, but it is not essential, in my view, unlike the recording reports which I designated must go in. This one could have been in, should have been in, but all the information on it is the standard information that is collected by the nursing staff anyway. It is generated for the purposes of our clinical audit work and our database.
Q I am going to leave that on one side and deal with the rest of the documents. The rest of the documents which are cited in Appendix One consist wholly of correspondence?
A Yes, that is right.
Q You have admitted that some of them are original documents, original letters – that is, letters coming from others to you?
A Yes.
Q Quite clearly originals, others are top copies which have been sent by you to others, and others are copies, copied to you, passing between third parties?
A Yes.
Q We see that in Appendix One. First of all, if I can take this globally, these documents do not appear in the medical records, the main medical records?
A No.
Q What is the overriding reason, if there is one, as to why these documents are in the special cases file only?
A Because when Child D was discharged from our hospital he was discharged with a label or diagnosis of child protection concerns. There would be no further involvement of our hospital in medical matters and, therefore, as part of our policy all correspondence, particularly child protection related correspondence, would and must go in the special case file, not in the major main hospital medical file. That is the policy that we had at that time.
Q In Appendix One there are, as I say, I think it is 28 letters, if my maths is right, and
I am going to take you serially through them, very briefly, and I am going to ask you two questions in relation to each one. First of all, looking at the document, whether in your view it properly fell within the policy that you described, and secondly, whether or not you would do anything different today.
A Yes.
Q We have been told that this SC file, the way it has been photocopied, runs from front to back, so we started at page 313 and so we are going to have to go backwards through the bundle. Do you understand?
A Yes, fine. Yes.
Q The first document, therefore, is at page 305, in March 1995, about three months after this child is discharged. Looking at that document, Dr Southall, was that properly within the policy that you have described?
A Yes, it was. It mentions factitious illness. It is not the sort of thing that we would want in medical records that were available to people, numbers of people that did not have to know. It related to issues with regard to the family rather than the child themselves per se.
Q The reference I think is five lines from the bottom of that paragraph. Is that right?
A Yes, it is.
Q Turn, please, to page 304. What do you say about that?
A Exactly the same argument. The letter on its own does not reveal child protection concerns but of course it is attached to the report which you just mentioned, which does contain concerns. This was about Child D being admitted for further investigation by Professor Warner.
Q I should have asked you in relation to the first document, and I ask you it in relation to this: Would you file these any differently today?
A No, I would not.
Q Page 281, please. We are now in May, 14 May 1995. This is from Professor Warner to you. First of all, did that fall within the policy that you have described?
A Yes, it would fall within the policy.
Q What about today?
A I accept that it does not contain any information that could link it to child protection concerns, so I do not have a problem with it going in the main medical record, but it seems in my view preferable to have the policy and have all of the correspondence in one place; but
I would not have a problem with somebody saying, “Well, this should be in the main medical record” or “could be in the main medical record”, I think is the way I would look at it.
Q When we see the dates on these letters can you help the Panel please as to when it would have been that the document would have been filed?
A Shortly after their receipt I think.
Q Page 279, please. On the top part of the page is that your writing?
A Yes, it is.
Q Did you make the SC number reference in your writing?
A I do not think that is my writing.
Q Is this a document which was correctly filed in the SC file in accordance with the policy, or not?
A Yes, it is.
Q What about your approach today?
A The same. I think it should be there.
Q Can you turn on to page 277. This is you to Mr Banks.
A Yes.
Q Again, the same question: Was that filed in accordance with the policy, or not?
A Yes.
Q Why is that?
A Because it is all about child protection.
Q Can I draw your attention for comment, if you wish to make any, to the bottom of page 277, the final paragraph.
A It is self-explanatory.
Q What about today?
A Yes, I think it should be in the special case file only.
Q Page 276 please. This is from Dr Rodgers, the GP, to you, and we are now in June 1995, six months down the line. On the top right-hand corner is that your writing?
A Yes, it is.
Q Was that filed, in accordance with the policy, in the SC file only?
A Yes.
Q Do you have any reservations about that?
A Only that I would be happy for it to go in both.
Q Given the fact that it only went in one, what is your view?
A I think it was appropriate, given the blanket policy. He was not coming back to our hospital, there was no clinical involvement. The only involvement was child protection.
Q Page 275, please. This is Professor Warner to you. There are two pieces of writing on this. First of all, the word “File”, is that your writing?
A Yes. I was looking at 275A. Yes, “File” is mine.
Q The number?
A I do not think that is my writing.
Q We have seen a number of instances where you have commented to the same effect, that the numbering is not in your writing. Who, as a matter of system, would note the numbering on the document?
A Usually my secretary.
Q The number that we see on that document, for example, is different from the special cases file number.
A Yes, it is.
Q Can you help there about what the apparent instruction to file may mean?
A Well, it may be that my secretary was not sure which file to put it in, because it does not say “File S/C”, it just says “File”, so she may have looked it up on the hospital computer system, his name, and got the number. Then at the top there is this “S/C”, so she may have realised that all correspondence was going into the SC, having looked at the hospital file, possibly. I mean, I am speculating, I do not know.
Q The “S/C”, is that your writing?
A I do not think it is. I am not sure though, but I do not think so.
Q Again, same question, looking at the body of this document, was that apparently filed in accordance with the policy, or not?
A Yes, it was appropriate to go in the SC file.
Q Should it have gone into the medical records at that time, or not?
A It could have done, but there is the word “case conference” on it, so I think it should not have done in my view.
Q Turn on, please, to 273. It is a letter from Professor Strobel to Dr Rodgers,
5 September 1995. There are two pieces of writing: the word “File”, is that you?
A That is me.
Q The same hospital number?
A Yes.
Q Is that your writing?
A No.
Q Now, I am deliberately not taking you through the whole of the body of a lot of these documents. The Panel have read them and will be familiar, and can read them again. What do you say about the justification for putting this letter solely in the special cases file and not in the medical record?
A The same principle again, the policy was there. Just reading this, there are some concerns about modalities of admission, but, just looking at it, there is no real reason why it could not have gone in the main hospital medical records, but I think the overriding issue was the policy.
Q Next, please, in chronological terms, we move now to page 265, and we are now in October 1996, so we have jumped a year.
A Yes.
Q It is yourself writing to Mr Banks. This is filed, as we know, in the special cases file only. What about the justification or otherwise of filing this in the special cases file alone?
A Well, this is absolutely purely child protection. It is appropriate in the special cases file only then and now.
Q 264, please. There should be a 264a inserted in the bundle where you will see that you are one of the persons being copied into this.
A Yes.
Q Again, sorry to go through the same form here, but we see two pieces of writing on 264. Is the word “File” your writing?
A Yes, it is.
Q What about the numbering?
A That is not mine.
Q This was filed in the SC file alone. What do you say about that?
A Again, it fits with the policy. However, there is not anything in it that is about child protection. It is a copy letter to me. The prime person receiving it is the GP of course, which is the most important person. Professor Warner is important. I am involved because of the child protection issues only. So I would not be averse to it being in the main medical record, but there is really not much point, but I do not have a problem with it.
Q Can we just pause for a minute. This is October 1996, which is almost two years now after the child is admitted for that short period in 1994. What hat are you wearing two years down the line?
A The child protection hat.
Q What does that mean?
A Well, I was still concerned about this child’s well-being. Professor Strobel and Professor Warner and the GP all knew that I was concerned still, although I was getting more distant from it at that time, I remember that, and I think it was Dr Whiting’s involvement which brought it back, if you like, more into my immediate attention.
Q Dr Whiting was?
A She had taken over as a consultant community paediatrician in the local area where the family lived.
Q As of October 1996, when documents first of all were being copied to you, what did you understand the reason why others should be copying you into this correspondence?
A I just think that quite often there is a system that is set up and it just carries on, and Professor Strobel was continuing to keep me informed of what was happening to the child.
I know he was still concerned as well about him. At some point we did have a strategy meeting at Great Ormond Street Hospital about him. I cannot remember exactly when it is without going through the records. He was keeping me informed because of the child protection involvement. I am not an allergist. None of this information is material which
I could have much of an input into.
Q Turn now back to 262, and a letter from the social services to yourself.
A Yes.
Q Why was this letter filed only in the special cases file?
A Because it relates to child protection concerns and it was from a social worker, copied to Mr Banks, Social Services, Newcastle.
Q On the second page, on 263, on the last line, we see the observation made by
Mr Haverson, and then there is an asterisk and somebody has written the words there appearing. Is that your writing?
A Yes, it is.
Q What do we understand that comment to signify?
A I remained concerned about this child. I thought there was something going on here in this family that had not been addressed, and the reason why the illness was being exaggerated related to some problem in this family that was not being addressed properly. Social services were clearly involved already in the family for care, not protection reasons, and I was concerned that there was missing data somewhere in the care of this child that needed to be addressed. So I was not happy with his opinion that there was no need for further concern.
Q Now, the next correspondence begins at 261, which appears to be a fax. This clip begins at 261, Dr Southall. There is a fax cover sheet, and towards the bottom it says, “Attached is chronology re: [Child D]”, and if you go back now to page 245, if you begin at 245 and run it on to 260, is that the material referred to in the fax header?
A Yes, it is. I should say I had already had a phone call at this stage from Dr Whiting outlining the concerns that she had had, completely independently of me, about the family, and this fax followed that telephone conversation, which is not recorded.
Q We will look at the document in a moment, but just by way of introduction, what was your first contact with Dr Whiting, the consultant community paediatrician, phone call or letter?
A Phone call.
Q Do you understand why she should be telephoning you?
A I presume that she had seen somewhere that I had raised concerns about Child D.
Q In correspondence?
A Yes. She was a community paediatrician so she would be involved in community child health issues.
Q So looking at 245, we see the date there, it is exactly two years since he was discharged from your care in the hospital.
A Yes.
Q She refers to the chronology, and then over the page, beginning at page 246 to 260 there is the chronology prepared by Dr Whiting. Why was this document, together with the covering letter from Dr Whiting, why was that filed solely in the special cases file?
A Well, firstly, the fax cover comes from Rosemary Marson, Clinical Specialist Child Protection, that is page 261, so this is about child protection issues.
Q So just pause and look at 261. Rosemary Marson, Clinical Specialist Child Protection. What is a Clinical Specialist Child Protection?
A I suspect, I cannot be sure, but I suspect she is a nurse in the community health field who specialises in child protection, I suspect, but I am not certain.
Q So again this may be obvious but I need to ask it: what would you understand to be the link or connection between Rosemary Marson and Dr Whiting?
A I suspect they worked together when there is a child protection concern particularly.
Q Looking at it now in 2006, ten years down the line, what is your view about this being filed in the special cases file only?
A Completely appropriate for the policy reasons.
Q Now, I am going to ask you to move again back to 229. 229 to 244 are, I hope this is uncontroversial, photocopies of what we have just been looking at.
A Yes.
Q With extras, and I am going to draw your attention to them, but they are photocopies. Can you help us at all as to why it might be that there are two versions of this material in the special cases file?
A I think that the first one is the fax and the second is by letter. That is what I think is the most likely reason.
Q Let us go and look at 229 for a minute, and we see that on the face of that document there is some writing “S/C File”, is that your writing?
A Yes, it is.
Q Was that a direction to somebody, secretary or whoever, to file it in the SC file?
A Yes, it is.
Q By you?
A Yes.
Q Then the actual document, the chronology, as we just move through it, on many of these pages are matters which are underlined or asterisked in one column or another. Is that your writing, Dr Southall?
A Yes, it is.
Q On a few occasions there are comments written in. Is that written in your writing?
A Yes, it is.
Q In particular, can I take you to 235, please, in the right hand margin; can you read that writing?
A Yes, I can.
Q What does it say?
A “Frequent symptom in MSBP”.
Q “MSBP” being what?
A Munchausen syndrome by proxy.
Q On page 238, just before halfway down there is a reference to a quote from the notes, and in the left hand margin there is a series of letters. Can you help about that, what it may mean?
A I can, but I am not sure whether I should. I am sorry, it is difficult to explain why.
Q Let me just deal with it this way. Is that because this is in public?
A Yes. I am not very keen.
Q Right. Can I ask you in this way: does it relate to the issue of child protection?
A Yes, it does.
Q Then lastly in this clip, 244. Just under halfway down there is a series of notes, handwritten notes. Is that your writing?
A Yes, it is.
Q Again, do the notations on the documents help you in any way to consider whether this was properly filed under a policy relating to child protection issues?
A Yes, it was.
Q 227, please. This is a letter from you to Mr Haverson, and I just pause and draw your attention to 228, where there are the various people who are copied into this correspondence. Was there an approach here by you to copy people in, or not?
A Yes, there was, yes.
Q This letter, as we know, because you have accepted it, was filed only in the special cases file.
A Yes.
Q The reason for that?
A It is about child protection.
Q I just ask you, please, to look at the first couple of lines. First of all, you say, “Thank you for letter of the 10th of December”. I just note in passing, to help the Panel, that is page 262, and then I am not going to read this out, but I just invite your attention, Dr Southall, and the Panel’s, to the first few lines.
A Yes.
Q Again, can I have your blanket comment to that, please.
A It is just further information, particularly at this time, from Dr Whiting’s assessment that there are child protection concerns.
Q The last sentence on page 228, the last two sentences, there is a reference to
Dr Whiting attempting to sort out a multi agency meeting. What is a multi agency meeting?
A This is probably a case conference, which, as you know, happened later.
Q We move forward, please, to 215. This is you to Dr Whiting, and what is the reason why this was filed in the special cases file only?
A The policy, it is child protection then and now.
Q Turn to page 214, please. This is a letter in respect of which you were copied in from Dr Whiting to Professor Strobel, and you were one of a series of people who had been copied into this. I draw your attention please to 214a. Looking at the list of people, is that correct?
A Yes.
Q On the main page, 214, there are two sets of writing and the word, “file”. Is that you?
A Yes, it is.
Q Was this directed to be filed in the special cases file by you?
A It does not say so on there.
Q But that would be your feeling.
A It should be.
Q The reason?
A It is child protection. It is part of the policy then and now.
Q Just looking at 214a, and looking at the list of people who were copied into this,
Mr Haverson is a social worker in the disability team.
A That is right.
Q From your standpoint, what was the relevance of the disability team being involved in this?
A Certainly Child D did have a major allergy problem with what could be considered special needs as a child. There is no question about that. I think that is why Mr Haverson was involved. The word, “disability”, though is not quite in keeping. It is a little bit suggesting that he was disabled and one of the concerns I had was that perhaps he was being inappropriately disabled by being pushed around in a pushchair and things like that, but he is not involved in the child protection side of social services.
Q Turn to page 208, please. This is Professor Strobel to Dr Whiting. We see in the middle of the page there the word, “file”. Is that your writing?
A Yes, it is.
Q This was found in the special cases file only. Was that correctly filed or not?
A Yes.
Q The reason?
A It is part of the policy and it does discuss child protection issues. It talks about the strategy meeting that had been held at Great Ormond Street Hospital.
Q Can I just draw your attention, for a comment please, to the second bullet point and to the last bullet point on page 208? Do you have any comment to make about that?
A It was felt that a case conference was going to have to be the next way forward in trying to sort out the problem.
Q I think the next document is at page 196. This is you to Mr Evans at social services. Mr Evans is there described as the child protection co-ordinator, and the letter is copied to
Dr Whiting, Professor Warner and Professor Strobel. There is a reference in that letter to the Children’s Act.
A Yes.
Q And a reference in the last line to a case conference. Again, looking at this globally, what was the reason why this was filed in the special cases file alone?
A The policy. It is now three years down the line from the admission.
Q Not quite.
A Not quite, but in the third year. It is about child protection so I think it should be in the special case files both then and now.
Q Two days later, at page 185, you write to Mr Evans again. In between times,
Mr Evans had replied to you on page 194.
A Yes, that is right.
Q At 194 we see the word, “file”. Is that your writing?
A Yes, it is.
Q On page 185 there is no writing by you at all.
A No.
Q But as a matter of fact this letter has gone into the special cases file alone.
A Yes, that is right.
Q It says,
“Thank you for your letter. I am sorry that you feel unable as yet to proceed with a child protection conference on the basis of what I referred to in my original letter”.
You then deal with a number of specific matters referred to by Mr Evans in his letter.
A Yes.
Q Again, I am not going to read this out. What is the reason why this document was filed in the special cases file only?
A Policy. It is child protection so the same would apply now.
Q Can I deal with it this far? In the first paragraph are there matters touching on child protection issues?
A Yes.
Q In paragraph 2, are there child protection issues or not?
A Yes.
Q In paragraph 3 and over the page are there child protection issues?
A Yes, there are.
Q In paragraph 4?
A Yes, there are.
Q And paragraph 5?
A Yes.
Q And the final catch-all paragraph?
A Yes.
Q The next document is way back in the file now at page 76. Dr Southall, this is a letter from Professor Warner to Dr Smart, who I think was part of the GP practice.
A I am not sure, but probably.
Q If we look at page 77 we see that it is copied as well to Dr Whiting, Professor Strobel, you and Mr Evans of social services.
A Yes.
Q Professor Warner begins the letter by referring to a promise he made at the case conference.
A That is correct.
Q Looking through that letter, do you divine from the content of it reasons for it being filed in the special cases file alone, or not?
A Yes. There is the policy. There is the fact that it discusses the case conference and that it is copied to the child protection co-ordinator of Slough Social Services.
Q Just for completeness, I refer you on page 76 to the word, “file” and an arrow. Is that your writing?
A Yes, it is.
Q Do you have a problem with the fact that that document was filed in the special cases file alone?
A No.
Q Page 75, please. This is Dr Whiting to Professor Warner, 24 June 1997. Looking at the bottom of the page, you are one of those copied into this correspondence, do you see?
A Yes, I do.
Q When we see the word, “file” on that document, is that your writing?
A Yes, it is.
Q This was found in the special cases file only, as we know. What is the justification for that?
A It is the policy following the discharge. By itself though it does not contain, as far as
I can see, anything directly relating to child protection so there would be no problem if it was filed in the main hospital file as well.
Q Looking at that particular document today, nine years later, what would you do with it?
A I would put it in the special case file. I would not put it in the hospital main file myself, but I would not have a problem if somebody did.
Q Page 70, please. This is Professor Warner to Ms Davies at the social services, September 1997, and copied as we see on page 72 to a number of people, but not apparently copied to yourself.
A Unless it went over the page. I do not know.
Q We have only just been supplied with page 72. At any rate, it is in the special cases file.
A Yes.
Q Again, is there a justification for it being there?
A Yes, the policy, plus it does describe the child protection co-ordinator. That is who it is addressed to. It is also copied to the mother and I considered it appropriate that it is in the special case file only, then and now.
Q If we can just deal with that, that it is copied to the mother. Is there any particular reason in those circumstances why it goes into the special cases file?
A It is sensitive data. It is highly sensitive. If I was her, I would not want such a letter in a hospital record that could be seen by people who do not need to know.
Q Then there are three pages, at pages 48 to 50. This is a letter about Mrs D from somebody who was a nursing assistant.
A Yes.
Q This is filed, as I understand it, solely in the special cases file. Again, why would you seek to put that only in the special cases file?
A Again, it is about the mother. It is about her behaviour, not about anything to do with her child. It could be linked to the child protection issue. It mentions the child protection issue, so all in all, for policy reasons and also because of child protection then and now, it should be in the special cases file only.
Q If you turn back to page 41, you will see a letter from Dr Macaulay, consultant psychiatrist, addressed to yourself.
A Yes.
Q Dr Macaulay writes – I do not know whether Dr Macaulay is male or female –
“I am also enclosing a copy of an account by [name], the contents of which are self-explanatory”.
Clearly the reference there is to pages 48 to 50.
A Yes, it is.
Q Did you understand why Dr Macaulay might be writing to you?
A I think he understood how important that case conference had been to the child and he also, I think, knew that I was under fire over my work with this child.
Q When you say, “under fire”, can you be a little bit more specific?
A I think there were a lot of allegations being made about my involvement which were derogatory and were saying that I should not have been involved. I think he, if I remember this rightly, was supportive, very much so, of what had happened and how the case conference and what had been revealed there had been so helpful to the child and to the family.
Q When you talk about criticisms about your involvement, do you mean involvement after 1994?
A Yes, after that.
Q Can you now look, please, at page 31? This is Professor Warner to you. Is that your writing on the right hand side?
A Yes, it is.
Q Help us with the shorthand you use there, please.
A “Can I have [name] hospital and S/C file asap”, as soon as possible.
Q Who is that request made to?
A That will be my secretary.
Q Did she know you had SC files?
A Yes, she was using them all the time.
Q Professor Warner to yourself, 2 December 1997. We are now three years down the line, almost exactly.
A Yes.
Q The reason please for this being filed only in the special cases file?
A The policy, however there is really nothing in it that would be a breach of confidence to the family. The wheelchair question is really obscure to anybody who does not know the history, so it could have gone in both, and I have no problem with that at all.
Q The next document is at page 25. This is Professor Warner to Dr Smart and copied to you, Professor Strobel and, over the page at page 27, to another paediatrician, Dr Colby,
Ms Davies of social services, and Mrs D, the mother.
A Yes.
THE CHAIRMAN: Can I just take the opportunity to remind the press that if a name should slip out, they should not report it.
MR COONAN: Dr Southall, if you look at this document from professor Warner to
Dr Smart, copied, as we know, to Mrs D, can you tell us the reason why this was filed in the special cases file only?
A The policy, and the very fact that it has got copied to a child protection coordinator, would mean that it should only be in the special case file because of its confidential nature.
Q Turn back to page 21 please, Professor Strobel to yourself, December 1997. Looking at the first line, he has seen copies of the letters of Dr Macaulay and the nursing assistant that we have already looked at. What is the underlying reasoning for this being in the special cases file alone?
A The policy and the discussions in, particularly, the first two paragraphs.
Q You are directing particular attention to those two paragraphs?
A Yes, I am.
Q I should just ask for completeness, is that your writing where it says “File”?
A Yes, it is.
Q Then we go to page 16, Professor Warner in Southampton to Dr Smart. Is that your writing where it says “File”?
A Yes, it is.
Q I just draw attention to the last paragraph:
“However there appear to be continuing exchanges of correspondence between various individuals who have been involved with his management in the past, copies of which his parents have. This obviously is having a major undermining effect and maintaining an acrimony which I feel ought now to be resolved.”
Pause there. Do you want to make any comment about those observations by
Professor Warner?
A I completely support Professor Warner in that statement. I think there was time to draw a line under it all. The situation was improving, everything was going well, and so
I agree completely with him.
Q Why was this document filed solely in the special cases file?
A Because of the policy and perhaps, in part, because of that last paragraph. It would be best I think if that was only in the special case rather than main hospital file, but I do not feel very strongly about it. It could be, or both – not either, both.
Q The penultimate document I ask you to look at is on page 9. Again, this is a letter from Professor Warner, once again to Dr Smart and several months later – three months later. This was found in the special cases file only. Is that your writing where it says “File”?
A Yes, it is.
Q What is the reason why this was in the SC file alone?
A This is nearly four years after. It is part of the policy. It does not contain anything about child protection, so there would be no problem if a copy was filed in both the special case and main hospital medical file.
Q Finally, on page 2, nearly three months later, a further document from
Professor Warner to the GP, copied to you. We see that on page 4.
A Yes.
Q If I may say so, the same sort of structure set out as the previous one we have looked at?
A Yes.
Q This is in the special cases file alone. Is that your writing on page 2?
A Yes, it is.
Q What is the reason why this was filed in the special cases file alone?
A The policy, but again, looking at the last paragraph, there is a reference to case conferences and so I think this should only be filed in the special case file.
Q Dr Southall, I have taken you through each of the letters cited in Appendix One.
A Yes.
Q I just want to ask you this about the operation of, first of all, the policy, and in so far as you made an individual judgement in respect of a particular document, that these documents ended up in the special cases file. Was there any time in your judgement, as a result of this policy or individual judgement being made, that Child D was or may be at risk in the future?
A I cannot see any risk to the child at all.
Q Did you treat this child at any time after December 1994?
A No, I am not an expert in allergy. The child protection problems had resolved. There was no reason why he would ever return to our hospital in Stoke-on-Trent; it is about 100-odd miles from Slough where they live. If he did, just supposing he was in a motor accident going past –because that is the only thing I can think of, a road traffic accident on the M6 – and got brought into our hospital, the notes would be resurrected, the notes would have everything in about the risk of anaphylaxis and allergy.
Q When you say the notes?
A I mean the main hospital records, and because he was under me I would be asked and I could also bring out the special case file and go through all that. All this information would be available should it be needed.
Q If another clinician, let us say in Southampton, or you have mentioned a town just outside London and the West of London, if any one or other of those paediatricians or clinicians wanted information about this child which they may or may not, rightly or wrongly, have had on their own files, for whatever reason, could they have got hold of it?
A Yes, they could have written to me. I would have been reluctant to have revealed to anybody, without permission of social services, anything to do with child protection. That was my approach to this. I felt that child protection is led by social services. Even though
I am a doctor in a hospital involved in it, if somebody wanted access to these they could get the medical material but anything to do with child protection I would usually refer to social services.
THE CHAIRMAN: Mr Coonan, would there be a convenient moment for us to take a break shortly?
MR COONAN: Madam, yes, certainly.
THE CHAIRMAN: Is that satisfactory?
MR COONAN: Yes, indeed.
THE CHAIRMAN: Thank you. We will break for twenty minutes now. It is about twenty-five to twelve. That will take us to five to twelve. I need to give you the usual warning, Dr Southall.
THE WITNESS: Yes. Thank you, madam.
MR TYSON: Madam, can I just add something? There has been a reference to the area where this mother lives and I wonder if a warning can be given when the press returns.
I notice one or two have left.
THE CHAIRMAN: That anonymity extends to the location as well as the name?
MR TYSON: One would assist the other.
THE CHAIRMAN: I will repeat that afterwards.
(The Panel adjourned for a short time)
THE CHAIRMAN: Mr Coonan, before we begin there are two matters. First, I would like to remind any press present that the anonymity of the families involved in this case should be preserved in anything that is published, whether it is name or location.
The second matter is that during the evidence before the break you asked Professor Southall a question which he said he was unable to answer in public session. The Panel have asked that they would like to go into private session in order to enable Dr Southall to answer the question. Do either of you have any comment on that proposal from the Panel?
MR COONAN: Speaking for myself, on behalf of Dr Southall, I would have no objection to that, and if the Panel wish to hear it then of course they are entitled to hear it.
THE CHAIRMAN: Mr Tyson?
MR TYSON: I have got no problem with your route, madam. Another way of dealing with it, which would be in semi-public session, is for him to write down on a piece of paper what those initials stand for, which is what I was planning to do when I asked him questions in order to deal precisely with that, and for that bit of paper to be shown to everybody in the Panel and to be recorded in the Panel’s list of documentation.
THE CHAIRMAN: I see, just looking at the Panel, that they would prefer the route for allowing Professor Southall to answer the question verbally. Since this refers to evidence that was given before the break, before you move on now would seem to be as appropriate a time to deal with this matter as any. In order to permit Dr Southall to answer the question the Panel will resolve to go into private session.
MR COONAN: Thank you, madam.
THE CHAIRMAN: The Panel is now going into private session. We will call the public back as soon as this one matter has been dealt with.
STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW
AND THE HEARING CONTINUED IN PRIVATE
(Please see separate transcript for hearing in private)
STRANGERS HAVING BEEN READMITTED
THE CHAIRMAN: You can continue, Mr Coonan.
MR COONAN: Thank you, madam. (To the witness) Dr Southall, before leaving this document, could you just have a look at the original special cases file dealing with this material, please. (Same handed) I have had it handed to you deliberately open at that section. Can you at the same time go back to our bundle C6 and open the bundle of photocopies at page 229. I just want to clarify one point, please. In our bundle at 229, following through to 244, there are a series of pages on which, as you have already explained, you have underlined various passages.
A Yes.
Q There were comments and marks in the margin.
A Yes.
Q Now, looking at the original file, which is in front of you, looking at that, are the markings and underlinings on a photocopy of the document or on a hard copy, or on a hard document, if I can put it that way?
A A hard copy, I think.
Q Because if you go back to page 229 itself in bundle C6, you will see a reference to “S/C file” in your writing, as you have described it.
A Yes.
Q Do you see your original writing on that equivalent document?
A Yes, I do.
Q So can we assume, as you said earlier in your evidence, as I understand it, that was in fact on a hard copy?
A I think so, yes.
Q We also have in our bundle C6, at pages 245 to 261, what is in our bundle a photocopy. Is there the same clip of correspondence in the original SC file?
A Yes, there is.
Q Is that a hard copy document, a photocopy or a fax?
A Well, I think it is a copy, a photocopy.
Q So the Panel can of course see the bundle for themselves, but pages 245 to 261, is that a photocopy, unmarked photocopy?
A Yes.
Q Thank you very much. That is all I ask you about C6. Can you just put the original file to one side.
Now, Dr Southall, you were explaining to the Panel before we had the short adjournment in effect about access to these records.
A Yes.
Q Where in fact was this particular special cases file kept as far as you recall?
A In the secure room in the Academic Department of Paediatrics.
Q Where physically were the main hospital file notes kept in the hospital?
A There are two sites to the hospital, and I think they are the site, not the site where the children’s unit is; I think it is called the Sutherland Library.
Q It may or may not matter, but when you say “two sites”, what is the difference between the two sites?
A About half a mile.
Q When you needed to get access to the main hospital file – I say “you”; “one” needed to do that – what was the procedure that you had to adopt to go and get access to the notes?
A Well, my secretary would request them from the medical records department and they would eventually arrive.
Q When you say “eventually”?
A It depends on the speed at which you wanted them. Now, I cannot remember what it was like then. Now it is good. If you want it in an emergency, you can get them. I can only talk about now. I cannot remember what it was like then, although I think it was not quite as good as it is now.
Q During the period when you were suspended, do you know what happened to these notes?
A I am pretty sure that these notes were looked at as part of, and I know they were, they were looked at as part of the inquiry into my child protection work, this case.
Q So how did it come about that they were looked at? Did you get them and hand them over to those who were charged with carrying out the inquiry? How did it happen?
A Well, when I was suspended I had to leave the hospital immediately. The next I knew about this was I think almost eighteen months later, when I realised that one of the cases being considered by the hospital, as part of their child protection inquiry, was this case. So
I was sent some questions to answer, which I had to answer, and in answering I think I was given a copy of this file.
Q Of the SC file?
A Yes. I am pretty sure I was, because they were detailed questions and I would have needed to see it in order to answer their questions.
Q So how did anybody get access to the file in your absence?
A Oh, I mean, the hospital could access all of our – I mean, we are in the hospital itself. This is not a building, the Academic Department, which is somewhere else separate from the hospital, it is a hospital building with security, fire alarms, everything. The hospital management had the secure room codes, they could access everything, but only certain obviously senior people would be able to do that.
Q Can I ask you, please, to look at bundle C2, and if you go to tab 4 at (k). This is a series of letters from pages 1 to 36 that we have looked at already, and I just want to ask you a number of questions arising out of that series of correspondence. On page 1 we know that in October 1997 Mrs D requests a copy of her child’s notes. That is self-evident from the first letter.
A Yes.
Q That is in 1997, but there is further correspondence involving Mrs D and the Trust, principally somebody called Mr Fillingham. Did you know Mr Fillingham?
A Yes, I did.
Q If you go to page 16, that on 30 March 1998 Mr Fillingham writes to Mrs D, and says in the second paragraph:
“You have already had access to [Child D’s] records under [the] unit number…”
and the number is set out. That is the hospital number?
A Yes, it is.
Q “…some time ago. As you are already aware there has been extensive correspondence and copy documentation from agencies such as ….. Social Services, Great Ormond Street ….. and [a] Health Authority. The Trust is unable to disclose those documents as they are confidential and do not form part of [Child D’s] records.”
Were you aware of this correspondence passing to and from Mrs D and Mr Fillingham up to that date?
A I cannot remember. I might have been, but I cannot remember.
Q If you move to page 23, Mrs D in January 1999 is writing to the Ombudsman, and at the latter part of that letter Mrs D expresses this:
“It is my view that Professor Southall at North Staffordshire has not acceded to my request for access to all my son’s medical records, as the hospital claims that some of these are the property of Professor Southall, as they form part of his research.”
I pause there. Whatever may have been a view expressed by the hospital, were you at this stage expressing the view that she could not have access to these records because they were your property?
A No.
Q Were you expressing the view to anybody that she could not have access to these notes because they formed part of research?
A No, there is no way there was any research going on on this child at all at any stage.
Q Then on page 26, in March 1999, Mr Blythin writes to Mrs D and says, in the second line,
“I confirm that there is no additional documentation other than that which was sent to you on 30 March 1998. There is however copy documentation from agencies such as social services, a community health authority and a general hospital which the trust is unable to disclose”.
There is a reference in the next paragraph to computerised records, to which I shall come back. Dealing with that main paragraph, insofar as the trust was taking that stance, was that stance on your instructions or not?
A No, it was not.
Q Still in the same bundle, C2, I want you now to move please to Section 6 and turn in that to Tab (b). Bear in mind that the last letter I drew your attention to was in March 1999 and we are now in April. Although we have this document here, which we have been supplied with, as an unsigned copy, I do not know, do you accept that you sent this to
Mrs Dawson?
A Yes, I accept that.
Q Did you know Mrs Dawson at that time?
A Yes, I did.
Q Had you had dealings with her before April 1999?
A Lots of dealings, yes. She was our manager.
Q When you say, “our manager”, what does that mean?
A Child health directorate manager. She was one of them anyway.
Q Again, for those who do not operate in hospital settings, how did she fulfil managerial functions vis a vis clinicians?
A She looked after the management side. She was the deputy business manager so she would attend consultant meetings. She would relate to us with regard to any tertiary hospital admissions, for instance. We had a lot of dealings with her.
Q Did she know about the security arrangements?
A Yes. She was involved in setting them up, I think.
Q She was involved in setting them up?
A I think so. I mean, you would have to ask her, but I would have thought she was, yes.
Q Did she know about the existence of special cases files?
A Yes.
Q How did she fit into the management tree, if I can put it that way? We have in our minds, for the minute, Mr Fillingham, then Mr Blythin. Where did Mrs Dawson fit into that?
A Mr Fillingham was the chief executive. Mr Blythin was the chief nurse at the hospital. Then there was a business manager and she was the deputy business manager.
Q Who was the business manager?
A I cannot remember when it changed, but Peter MacAloon was one of them. I think he was earlier. I cannot remember who it was at this time.
Q On a day to day basis, in so far as there needed to be a managerial interface between clinicians and an administrative structure, who did you deal with?
A I think Mrs Dawson was pretty much the key person.
Q This letter – can I take you to it, please –
“Dear Diane, re Child D complaint: In no way was D subject to any form of research in my department”.
Was that true?
A Yes, it is.
Q You go on,
“I enclose his special case file”.
I will stop there. Did you enclose his file?
A It says I did.
Q Is there any reason why you would not?
A No.
Q Continuing,
“so that you can look through it and decide how you describe the various contents of this”.
I pause there. What were you inviting her to do exactly?
A Well, look at the different letters and the different bits of correspondence and decide whether they were social services, which hospital they came from and so on.
Q For what purpose?
A For the complaint.
Q Who was going to make the decision as to which, if any, of these documents should be disclosed?
A The hospital.
Q Then you go on,
“My view is that they are part of social services and other hospital records rather than being directly related to his admission to the North Staffordshire Hospital under my care as consultant paediatrician”.
Can you help the Panel, please, about that sentence:
“My view is that they are part of social services and other hospital records”?
What did you mean by those two elements?
A There were documents in there relating to confidential issues such as case conferences and strategy meetings, and then there was the correspondence that we went through this morning from other consultants to me or me to other consultants.
Q When you used the expression, “other hospital records”, is the emphasis on the hospital or the total phrase?
A I see what you mean.
Q Well help the Panel, please.
A Other hospitals, I think that is what I meant.
Q We have seen, with your assistance this morning, the other hospitals involved with this young child.
A Yes.
Q I am not going to mention them in open session. What is your view, Dr Southall, about the accuracy of the view you were then expressing in April 1999? Are you happy with that?
A Yes, I am happy with it, yes.
Q Was there any stage during the relevant period in relation to Child D or Mrs D when you prevented, or obstructed or were reluctant to disclose any of the documentation in the special cases file?
A No.
Q Dr Southall, I am going to turn to the subject of computers. Can you have, please, in front of you Appendix Two of the Notice of Hearing and Bundle C10? During the course of your evidence on Friday, you explained to the Panel that there had been a computer at the Royal Brompton and that had come with you to Stoke.
A Yes.
Q Secondly, there was a stand-alone computer in the academic department, but that that had been taken, or had access to it during the period of your suspension, and you came back and found that the password had changed.
A Yes.
Q Let us go back, please, because this is very much a stand alone topic in itself. In respect of the data on the Brompton computer, was that data at any stage transferred across to the Stoke computer?
A Yes.
Q I am speaking generally now.
A Yes.
MR COONAN: What was the purpose in transferring the data?
MR TYSON: I was muttering under my breath, but my understanding of the evidence was that it was the same computer that went from Brompton to Stoke.
MR COONAN: That is right.
MR TYSON: So he did not have to transfer the evidence because it was on the same computer.
MR COONAN: I am sorry, I will deal with this in my own way. You had the computer from Brompton to Stoke.
A Yes.
Q On Friday you spoke about that computer being an Apple.
A Yes, an Apple Mac.
Q And the Stoke computer having a Windows system.
A That is right, yes.
Q And at some stage there was some transfer. You referred to that.
A Yes.
Q I am now going to ask you about that topic. Did you, or others under your direction or control, transfer all the data from the Brompton computer to the Stoke computer?
A Yes.
Q The reason why you did that?
A I think – I cannot remember the exact reason – that it must be something to do with the operating systems being compatible with the hospital operating system, because almost everything was becoming Windows driven rather than Apple driven. It is something like that, but I cannot really remember why.
Q Was the Brompton computer which ended up in Stoke, was that used to store Stoke data?
A Yes.
Q The Brompton computer.
A Yes.
Q Whatever was operating at any particular time may or may not be a matter for further scrutiny, but I am concerned now with particular data which appears in C10. We know from the evidence given by Ms Ellson, which was read to the Panel, that on the Stoke computer there were two databases, SC and recordings.
A Yes.
Q Looking at the Stoke computer, what do we understand to be the intrinsic difference between the two databases?
A The SC patient data file is just a summary of the name, address, numbers; very basic information to help us with clinical audit and for getting the patient up and finding that patient, if you like.
Q The recordings database?
A That was different. That is a database for sending out information on the analysis made of the recordings. Either sending it to the hospital main file or sending it out to others, depending on the stage and development of the computer database system.
Q Let us deal with each individual patient first and then we will deal with a number of general matters at the end. Let us go straightaway to deal with child D. If you look at C10, pages 1 and 2, two preliminary matters, please. Do you see in the top left hand corner, “SC File 314”?
A Yes.
Q In the left hand margin, where we see, “Records 4449”, can you help from your standpoint with what that number means?
A I think that means the total number of special case files.
Q Held in effect by you at that stage in Stoke?
A Yes.
Q Did that include Royal Brompton SC files?
A Yes.
Q This document is headed, “Patient’s data”. What was the purpose of this?
A It is to summarise issues such as the name and address, the GP’s name and address, the diagnosis summary and admissions summary. It is for us to search a patient if we needed to do a clinical audit. Suppose we wanted to know every patient with, say, upper airway obstruction. We could put that in under the diagnosis, possibly, and bring out 20-odd patients, perhaps. It depends what it was, but it is a database.
Q The information which is in this document as we see it, is that information to be found elsewhere in the notes?
A Yes. This is already in the hospital main medical record collected by the admissions clerk plus the nursing staff, plus the medical staff.
Q Can we look, please, at two non-exclusive – I emphasise this – examples of that? Look, please, at C2, Tab 4 at (g). Dr Southall, I do not want to spend over long on this, but if one was to look for the information contained on page 1 of C10, would one find it in the body of these notes?
A Yes.
Q In particular, would one find the diagnosis?
A Yes.
Q Look, please, at page 601 and following. Can you help us with that?
A In the middle of the page, the two phrases from the patient data form are actually written in the clerking-in notes there,
“Low body temperature. Multiple allergies”.
Q Others may wish to do so, but I am not going to take over long on this. You say the information is in these notes.
A I do.
Q The other aspect of this – can I ask you now to go back to C6, the SC file, to page 313? Help the Panel, please, by looking at page 1 of C10 on the one hand. Just pause for a minute, by looking at page 1 of C10 and page 313, would you like to comment on each of these documents?
A They are the same document except in different format.
Q Thank you. If you go to the second page in C10, as a document is it different from or the same as page 1?
A It is the same, but you can see there are some problems with this. It is not printing correctly. There is something gone wrong with the linkage to the printer, I think.
Q This was a document which was printed for Field Fisher Waterhouse on 31 October this year. Is that right?
A Yes, it is.
Q Did you have any difficulty printing that off?
A I did, yes, that is why I took a screen shot.
Q Just so we understand it, is the first page of C10, what has been called a “screen shot”, you did the printing off, so I am going to ask you, how did that come about?
A It is a button you press to print the screen and then it saves it to a clipboard and then you print it.
Q That is page 1. How does page 2 differ?
A Page 2 is straight from the computer to the printer. It should come out like 313.
Q Leaving aside the difficulty in printing page 2 in a clearer format, so far as page 1 is concerned, did you have any difficulty taking a screen shot there?
A No.
Q In relation to data stored in the computer coming up on the screen, would there have been any difficulty for anybody with access to the computer having a problem?
A No.
Q Just remind us, who did have access to this computer storing this data?
A Myself, Dr Samuels, the clinical nurse specialist, the computer department. Maybe a nurse on the ward, a senior nurse, if they wanted to we would show them.
Q That is all I ask about Child D. We move on to Child H please. We have been supplied in C10 with pages 3 running through to 9. Leaving aside pages 3, 4 and 5, can I ask you for your comments on pages 6, 7, 8 and carried on over to 9? Do those relate in any way, and if so what, to pages 3, 4 and 5?
A They are the same patient. He was not a patient in Stoke. He was a patient at the Brompton Hospital. Pages 6, 7 and 8 are the equivalent of the patient data form we discussed for Child D. Sorry, page 7 is equivalent to the patient data form – it says it at the top. Pages 7 and 8 are letters but they are on the Academic Department of Paediatrics heading --
Q Why is that?
A Because they are imported data from the Brompton, which I think – I am not sure – whether at the time we were in the Brompton we had a letter going automatically. It looks as if we did, but of course it has got the wrong header on it. It should have the Brompton heading.
Q If we take, for example, page 4, is there any other document in this clip which is in terms of the data in it, the same or similar to it? Looking at page 4 and page 6, can I invite your comment on those two, please?
A I think page 4 is the screen shot and page 6 is the physiological recording result.
Q Within the computer?
A Within the computer.
Q Look at pages 5 and 7?
A That is the same again.
Q Spell it out?
A The 5 is the screen shot, and page 7 is the direct printout.
Q Look at page 3 and page 8?
A Page 3 is the screen shot, page 8 is the direct computer printout.
Q I am going to concentrate on pages 3, 4 and 5. This, as you have explained, is a document which is capable of being seen on a screen, obviously because you have got it up on the screen for Field Fisher Waterhouse?
A Yes.
Q The data in there which we see in screen form, should that data in documentary form have been filed elsewhere?
A Yes.
Q Where should it have been filed?
A In the main medical record file.
Q The fact that it was not, can I have your comment on that please?
A It was policy at the Brompton for that to have been done. I directed it to be done. If it was not done there could be a number of reasons, but I do not know what they are.
Q That is page 3. Page 3 of course referring to September 1989 and page 4 relating to March 1990.
A Those are the two admissions.
Q The two admissions?
A Yes.
Q In respect of page 4, insofar as that represents data in that form stored in the computer, should that data have been printed off and stored in the medical records?
A Yes, the same principle applies.
Q Page 5 is in a different form in the sense that it is not addressed to anybody, and it does not have “Dear X”?
A No.
Q It is headed “Patient’s Data.” Insofar as the information stored in the computer which is manifest in this screen shot and is capable of being printed, should that have been printed off and placed in the main medical records?
A It could have been but there was not a policy for it to be so placed because that information is all available in the medical record anyway. This is for our purposes, as was the case with Child D. We talked about that.
Q I am going to ask you please just to look at a very small clip of medical notes from Child H’s notes for you to comment. Perhaps those may be distributed.
THE CHAIRMAN: This is D15.n (Same handed and so marked)
MR COONAN: Thank you very much. (To the witness) Dr Southall, I am looking, first of all, at page 3 of C10. This limited exercise is just to invite you to comment, please, to the extent that the material is to be found in the hospital notes.
A Sure.
Q With page 3 on one side, if you look please at page 12, which may be the last page in the clip, page 12 at the bottom?
A Yes.
Q Is that associated with page 3 in any way?
A Page 12 is the equivalent of page 3, but in a different kind of format. It is a proforma that is hand filled in rather that computer entered.
Q That may be, but the nature of the exercise is to see the extent to which there may or may not be information in another document compared with what is on the screen or in the computer. Do you follow?
A I do, yes.
Q In relation to that question, what do you say about page 12?
A Right. If we start at the top, the name and date of birth are both there. The hospital number is not filled in on this computer one but it is on the proforma. The special case number is filled in on both. The date of tape is filled in on both. The referring doctor is filled in only on the proforma, as is the referring hospital, only on the proforma. The reason for the recording is filled in only on the proforma, and then the results … There is a blanket one under “Results” on the computer but details on the four “Normals” under the results. Then recommendations is nil on the computer and “To re-admit when having cyanotic episodes for repeat recordings” comes under the “Follow-up” bit, not the “Recommendation” bit, on the computer.
Q Again, it may be obvious, but which is the fuller record?
A The one that is filled in the medical record. This is the proforma, and of course I am asking myself, looking again at this, how come there is a difference? I mean, what is this one, the computer record? How was it created? I cannot remember, I really cannot be sure.
Q I will ask you, please, whilst we have the clip of correspondence available, to look at page 5 of C10. If you go to the clip you will see page 1 at the bottom?
A Yes.
Q You will also see a medical report by you?
A Yes.
Q Pages 27 to 31.
A Yes.
Q Just taking those two documents alone for the minute, to what extent can you help the Panel? Do they underpin, if at all, the contents of the document at page 5 of C10?
A I think they are completely replicated in the medical record, all of the information on the computer, patient data.
Q Finally just two references, in C1, tab 2(d). These are admission notes in March 1990?
A Yes.
Q Again, forgive me, I am not going to go through this process laboriously. What, if anything, do you say to the Panel about these records in the main medical records, C1/2(d)? To what extent do they underpin the material on page 5 of C10?
A Again, the information is all there in different places in the medical record, but here there is quite a lot of information that is repeated on page 5, such as developmental delay listed under (4), and is on here as well.
Q That is page 5. Therefore, finally I ask you about page 4 in C10. You have just drawn the attention of the Panel to the admission notes for March 1990 and I am not going to go back to those, but in addition can I ask you please to look at C2? Looking at page 4 in C10 and this entry in tab (f), is there any linkage between the two in any way?
A Yes. The date, name, special case number is there. It is the recording result for 24 September.
Q That is the date of birth?
A I am sorry, yes.
Q 16 March.
A 16 March, sorry. The date on here is 16 March, yes. There is a link, yes.
Q More than just a link with the name and date of birth. What about the results?
A Yes, the results are far more comprehensive than is in the normal recording bit and the recommendations are more comprehensive than is in the – or different, even, too.
Q Should this page, in so far as it represents data stored within the computer, in fact have been filed in the medical notes?
A This one?
Q Yes, page 4 in C10?
A Yes, that was the policy, but I am not convinced … Because of this proforma, this is the one that ---
Q You say “this.” Can you refer to which one?
A I am sorry, page 14. This is the one that should be in the medical records for certain. This one is just the same but our computer format, so the fact that this, if this is in the medical records ---
Q Which it is.
A Which it is, then this is what matters. This is the original recording result for the child signed off by me, handwritten into a proforma. This is a computer data, probably a copy made by somebody to complete the records in the computer system. (witness indicated)
MR COONAN: Thank you very much. Madam, that might be a convenient moment.
THE CHAIRMAN: Thank you very much, Mr Coonan. It is now five past one, so we will break for one hour till five past two. I am obliged to repeat the usual warning, Dr Southall.
THE WITNESS: Thank you.
(Luncheon Adjournment)
THE CHAIRMAN: Good afternoon. I understand, Mr Tyson, you have found that material that Mrs Lloyd was referring to this morning.
MR TYSON: That is right, madam. We were looking at C6 at page 238, and we see that in August 93 Child D was admitted to the hospital there mentioned, and Mrs Lloyd enquired as to whether there were any other words recorded in the notes, and I have the clinical note for that entry from those hospital records, and perhaps it would be easiest if I were to pass it round. (Document shown to the witness and the Panel)
MR COONAN: Dr Southall, can we look at the last two cases in C10, please. First of all, Child A. Would you look at page 10 and page 11. These two refer to Child A. First of all, there is on page 11 what appears to be, using your description, a screen shot.
A Yes, of page 10.
Q On page 11 is a screen shot, is that right?
A Yes, that is right.
Q The data form is on page 10, is that right?
A Yes, it is.
Q Is there actually any useful information in either of these two documents?
A Well, not much. There is the name, the case number and the date of referral, but the date of referral is the same as the date, and I just have a feeling this is not really a proper record, remembering this was a long time earlier in the sequence, and I suspect that some of the data was transferred to the computer, but only a little bit of it, if you like.
Q The ultimate question is whether or not the data in this form, in other words either the form that we see on page 10 or in the form on page 11, or both, whether such a document if printed off should have been in the medical records?
A Well, there is so little on it. I mean, in theory, if you follow the original ruling, yes, but this was a long time earlier than the Dr Jawad letter for instance, so I think this is – I do not know what to say about it. It just does not contain much information at all, so it is not going to make any difference to the record, except to make it bigger by virtue of one page.
Q Is it going to assist any clinician at any time?
A No.
Q I now turn to Child B, and I want to look with you, please, at pages 12, 13 and 14. Page 13, is that a screen shot?
A Yes, I think that is a screen shot of page 14, yes, it is.
Q Screen shot of page 14. What is page 12?
A That is the patient data form as before, summary for the computer.
Q Before we look at the body of this material, we heard evidence from Ms Ellson that on 31 October you had been able to first of all have up on the screen and print off material in relation to the other three cases, but that you had some difficulty getting into the computer, if I can put it that way, in relation to case B.
A Yes, exactly.
Q Is that right?
A It is. I tried to put the name in and the number, and I could not get it to link anywhere in the computer. Then I tried it through the first name rather than the surname, that was later though, and then it did link. I do not understand why.
Q Did you think of the reason at the time?
A I think I suggested there may have been some corruption of the database.
Q Resulting from what?
A Well, it had gone away, passwords had been changed, it did not fit the printer. There was something about it that was not right, but it is speculation; I have no idea why.
Q At any rate, there was printed off pages 14 and 12.
A Yes, 12, 13, 14.
Q Well, 13 is a screen shot, so---
A Yes, true.
Q ---we are looking at 12 and 14 in relation to printing off the data in the computer.
A Yes.
Q The first question is this: so far as page 12 is concerned, the patient data document as printed, should a document in that form have gone on to the main hospital records?
A No, not really. It is already in there.
Q When you say “already in there”, where?
A All of the data that is on this form should be as part of the standard hospital admission main record. It could have gone in, there would not have been a problem with it, but it was not necessary.
Q Can I just ask you to look at one sheet from main notes, please. Madam, may this be D16? (Document handed)
THE CHAIRMAN: D16, yes.
MR COONAN: At the same time, if you have available, Dr Southall, C2, tab 5©(ii). Find that first, if you can, C2/5©(ii), and then go into the body of those notes and I think you will find it three pages in with number 33 at the bottom.
A Got it.
Q This tab that I have just drawn your attention to, (ii), is in the main hospital records, right?
A Yes.
Q Now, just looking at the two documents that I have drawn your attention to, page 33 at the bottom and this additional document D16, is that of any assistance at all in identifying data which may or may not be in the printed document at our page 12 of C10?
MR TYSON: Sorry, perhaps you can assist, I have not followed what page you are taking him to.
MR COONAN: Sorry, it is 33 of that tab, which is (ii).
MR TYSON: I have got it.
MR COONAN: Good. It is out of sequence, 33. (To the witness) Dr Southall, did you follow the question?
A Yes, just looking through---
Q Well, take your time and just look through it.
A ---the only thing that I can see that is not is the word “Bradycardia”, “recurrent apnoea” and “Bradycardia”. I am just looking for the word “Crawley”.
Q Well, can we just take two examples. The health visitor is mentioned on C12, do you see her name?
A Yes.
Q Her name is on page 33 at that time.
A Yes, it is.
Q Is the GP’s name referred to?
A Yes, the GP’s name is there. I am just looking for the address though. The GP’s address is not on there, but it is on this one. (Indicated)
Q Dr Southall, again, I am not going to go painstakingly through all the hospital medical notes, but what is your central point that you make about the material on page 12?
A This is for the clinical audit work for finding the special case files, it is a computer generated document as part of the database which assists with that kind of function, but the data within in is reproduced in various different places in the hospital medical record, which is probably where this was derived from; in other words, in forming this patient data a technician would have gone into the main medical records and obtained the data that we are talking about.
Q A hospital technician would do that. Would you do that on occasion?
A No.
Q What was the form of instruction to a hospital technician to do that?
A It would be “Fill in this form and then take it to the computer and enter the data so that we have a complete record for every case”, something like that, and of course that developed over time. It started off scantily right at the beginning and gradually built up. This is the most frequent patient we have seen, so this is probably a bit more detailed than, say, Child A – well, it is more detailed than Child A.
Q Turn over the page to page 13. I just set the scene, please, by looking at two aspects: first of all, the reference on the third line of the typed text, “Your patient was referred with recurrent apnoea – Crawley”, and then the date 1 September 1993.
A Yes.
Q At the bottom of the print the reference to the GP’s name and his address or her address.
A Yes.
Q Looking at that for a minute, and then looking at page 14, what is the relationship between 13 and 14?
A 13 is a screen shot of 14.
Q Just keep 13 open and at the same time go to C2, please, back to tab 5, and go to ©(iii), and there should be a 16 on the bottom of the page.
A Yes, there is.
Q Just pause for a moment, please. The document at (iii), that I have just drawn your attention to, you can take as being in the main hospital records.
A Yes.
Q Just help us, please, what is the relationship, if any, between that document with 16 at the bottom and page 13 in C10?
A It is the same document, except that at the bottom the copies are different in the sense that Dr Issler has also been copied in on the one that went out into the medical records, whereas the one on the computer for some reason has missed off her name.
Q What I want to ask you is this: is there anything in the computer screen shot, the same question applies to the printed version at 14 in C10, any difference in content between either of those and the document which was in fact in the medical records?
A No difference.
Q It is said, by way of allegation, Dr Southall, that these computer medical records were, as records on the computer, not in the best interests of the individual children. What do you say about that?
A Well, I do not agree with that. I think that having the computer database as well as the special case file system and a ledger to go with it is just different ways of making more efficient our reporting system on patients, and that was what it was designed to do, to help ensure that the GP and other consultants received the recording results, make it more efficient for us to enter them than by doing it by hand, like we used to do.
Q It is also said that simply because the information within the computer, insofar as that is a medical record, and insofar as it was not as a fact in the main medical records (and leaving Child B to one side for the minute), because of those factors that amounted to keeping a secret medical record on these children. What do you say to that?
A I do not agree with that at all. For instance, I did a lot of work in the paediatric intensive care unit. We had exactly the same kind of system there to help with intensive care management. This is just to make the keeping of medical data more efficient for the sake of the patient. It was not secret either, that is the other thing. None of this was secret.
Q Can you help us again? We are in public session, can you spell out, please, why this was not secret?
A Because the referring GP or consultant received the data; the hospital staff knew that we had the data, both in computer form and in the special case files system. It could be accessed at any time seven days a week by one of our staff if it was required. It is still available years later when many many records would have been destroyed or lost, especially moving hospital. This is not secret or hidden, it is open for people to look at. Obviously there are limitations because of the sensitive nature of the child protection material. That is another reason why we kept it in a secure place and so on.
Q A slightly broader question and moving away, therefore, from the specific allegation of secret medical records in relation to the computer, you were giving evidence this morning and indeed on Friday last, about the general policy approach whereby, particularly in relation to Child H and Child D, correspondence was not filed in the main medical record but was filed in the special cases file.
A Yes.
Q That point, in the context of this case, applies to those two children. When you adopted that policy, particularly in Stoke from 1992, was the policy that you have articulated here written down?
A I cannot think of anywhere. It may have been but I cannot find it.
Q Was it a policy which was, as it were, enunciated by you personally? Was it a policy of somebody else that you adopted? Was it a joint policy? You tell us, how do we understand the concept?
A As a group, remembering that the team we had at the Brompton came with us to Stoke, we had regular meetings, I think every week or every two weeks, in the department where we had minutes taken. There are minutes around. I have found some. We used to discuss things like this – how do we keep things secure? How do we keep the data? Where do we keep it? Can we improve the computer? Can we improve everything we are doing? These meetings occurred regularly. It is an evolution. It is not a sudden, one day there is a policy and one day there is not. It is an evolved policy over years.
Q I would like you to look, please, at C3, 7(d). First of all turn to (v). The Panel have seen this during Mr Tyson’s opening, but that was some time ago so I would like to revisit it, please. First of all, have you see this document before?
A Yes.
Q Who drafted it?
A I did.
Q We see at the bottom right hand corner, “23 march 1995”.
A Yes.
Q Is this the first version of it?
A I do not know. I cannot remember.
Q On our copies there is some handwriting in the middle of the page and it looks as if it has been – there is an outline of a square. It could be a post-it; I do not know if the original is around. Do you recognise that writing?
A Yes, this is my handwriting. This formed the subject of the inquiry while I was suspended as well. The inquiry team wanted to know how we had kept all our secret – special case files. That was a mistake. How had we kept them? Was it secure? Did we have policies? This was an appendix to a document that was prepared for that inquiry.
Q An appendix prepared by whom?
A By me.
Q You said these guidelines were drafted by you. Were they adopted by you and applied by you?
A Yes, they were. Our department applied them, the whole team.
Q Can we look at this, please, together. If we look under “objectives”, was this all focused on the existence of this secure room that you have spoken about, or was it wider?
A It was wider than that. It was how to look after the material that we were handling because we had major issues with regard to child protection.
Q Can we just look at each of the objectives, first of all,
“To identify the important features of the secure room”.
What does that mean?
A If you go down a bit I think it is to do with the independent burglar alarm, the automatic door closer and key-operated lock.
Q Secondly,
“To ensure information relating to child abuse matters is kept in a secure place”.
What information are you referring to?
A That is at the bottom.
Q Let us look at that, (i),
“Paperwork relating to Social Service/Police and Medical information on patient/child abuse, eg” –
I draw your attention to this –
“special case files; police statements; legal expert witness reports and evidence.
(ii) Files relating to controversy on covert video surveillance, monitoring and child abuse.
(iii) Videotapes relating to covert video surveillance.
(iv) Recording tapes of events relating to child abuse and covert video surveillance.
(v) Computer disks containing correspondence on any of the above.
Note: All sensitive correspondence/documents must be contained on separate disks. Back-up copies of these disks will be held in the Secure Room”.
Dr Southall, who was aware of these guidelines?
A Everybody in our department, plus the managers.
Q When you say you drafted them, were they distributed, were they pinned up? How was it handled as a guideline that is going to make any sense?
A We drafted them at the regular meetings we had. I cannot recall how they were filed. I do not know whether there was a policy folder. I just cannot remember.
Q Did those guidelines apply, as far as you were concerned, during the relevant period covered by the documents in Child D and Child H?
A Yes.
Q The last document in Child H is in 1998. Did it apply then?
A Yes, it would.
Q Two final questions about documents and computers and such like, Dr Southall. Do you adhere to the principle that medical notes are sacrosanct?
A Yes, I do.
Q If it were to be suggested to you that the integrity of the medical notes has been impaired or damaged in any way by the operation of the system that you have described, both on Friday and today, what would you say to that?
A I think we did our best to ensure that data was kept safely and securely, and could be accessed as needed by those who needed to see it only. We never threw things away, even though we were asked to. I cannot say it has always been perfect. I am sure it has not. There has been misfiling, I am sure, errors in the filing system just as there are in many hospital filing systems. But I think it was not a bad system. I believe it was Okay.
Q I am going to move on to a different dimension, and I am going now to deal with the point of time of the three factual allegations relating to H, D and M. I am going to ask you please to consider the case of Child D first, 15 December 1994. As you know, this relates to Head 17 in the Notice of Inquiry, Head 18 and Appendix Three. This morning we looked in some little detail at the background leading up to this child’s admission to the hospital in Stoke. For current purposes I am just going to ask you to turn up one of the entries, and you will find that in C2 at (g), page 610, Tab 4. Dr Southall, you had your attention drawn this morning to the fact that the note of Dr Suchak on 15 December describes a ward round involving yourself, and you told the Panel that you had no reason to dispute the fact that you were involved in a ward round.
A Yes.
Q Three particular matters I want to ask you about, just refreshing your memory from looking at this note, and indeed the note on the next page, 611, which we looked at this morning.
A Yes.
Q The first question is this: were the results of the sleep study normal?
A Yes, they were.
Q Secondly, would you have considered the concept of a delayed allergic reaction?
A Yes. It can occur if you eat something and it takes time to be absorbed and then produce the allergic response. If you inject something it is different. That would be instantaneous.
Q Thirdly, was this child in fact referred to Professor Warner?
A Yes, he was.
Q Quite apart from what is in the notes, do you have any recall of the events of that day now?
A The vaguest. I can sort of recall some of it, but it is really vague.
Q When did you first have notice of this complaint being made against you?
A Not until many years later. In its full detail, if you like, not until a couple of years ago. I cannot remember the date.
Q But a couple of years ago.
A Yes.
Q Again, just returning to a couple of elements of this, do you remember now telling Mrs D that the results of the sleep study were normal?
A I cannot remember what I said to her.
Q Would that have been something that you might have said to her?
A Yes, I would have had to have said that to her, because that is why she had come into hospital with her child, to find out what a recording system was going to show.
Q Can you recall saying to Mrs D that there was no such thing as a delayed allergic reaction?
A I cannot recall it.
Q Is it something that you might have said to her?
A Not that there is no such thing. I cannot see why I should have done because I| believe that there can be delayed reactions to food allergy.
Q What about the non-food situation and the question of immunology?
A If you had an injection, if you had an immunisation perhaps, you would expect the response to be fairly quick after that. It would be almost immediate, which is why you have the adrenalin around when you immunise such children.
Q Do you think there is any context in which you might have said words to that effect; in other words, that there is no such thing as an allergic reaction?
A A delayed one?
Q Yes.
A It may be because mum was saying something about these responses where he goes pale and has a low temperature; she might have said that these could have been a delayed anaphylactic response. She could have said that, and I would have said, “Yes, but they would not be the manifestations I would expect from an anaphylactic response, delayed or otherwise”. So it may be that she was hearing something that was slightly different from what I was saying. That is not her fault. That is just the way things can be when you are talking about this kind of complicated material. So I am not saying she is wrong about that; all I am saying is that I cannot remember how I would have put something like that.
Q Thirdly, do you remember saying to her that you wished to, or were going to refer her child to professor Warner?
A I think I did, but I would have to check the notes again. I suspect I did say that, yes, because it was in my mind to do so.
Q Leaving those on one side, I want to ask you, please, about your manner. When you spoke to her, insofar as you said anything at all to her, were you angry?
A I had no reason to be angry.
Q Did you raise your voice to her?
A Well, I do not raise my voice to patients or parents ever, not in my experience. I have to be clear about this. It is not something I do. So I do not think I would have been angry or raised my voice either.
Q Were you dismissive of her in this sense, that you wave a hand or an arm in the air, interpreted at least as a dismissive gesture, and turned away?
A That, again, I would not consciously have done to any parent or patient. If she thought I did, which is possible, then all I can say is that I am sorry, but it was never intended to make such a response to anybody. So we are dealing with things which I cannot remember in any detail in any sense at all.
Q If I can put it this way, leaving aside dismissive gestures or otherwise, were you at any stage on 15 December demonstrating your anger with this woman?
A I had no reason to be angry with her. What I was concerned with was: What is behind this? What is going on that is leading her, a clearly intelligent person, to be so inappropriately involved with the issues that she was putting forward? It suggested, and indeed it came to light later, that there were other things in that family that needed to be resolved and understood and that I was not aware of, nobody was aware of, until the case conference. Only then did at last something start to happen to help sort out the major problems in her family. So it was that kind of feeling that I had, not an angry feeling.
Q Dr Southall, that is all I am going to ask you about Mrs D and I am going to move to Mrs H and Child H, and the Panel are concerned here with allegations which are set out in heads 7, 8 and 9. Would you like to refresh your memory by looking at those notes for heads 7, 8 and 9? (After a pause) As we have seen when we were dealing with the documentary side of things, there were two admissions in respect of Child H, one in 1989 and the second one in 1990. Can we just look please fairly briefly at the admission in 1989? If you turn to C1/2(a), this is the referral letter from Dr Dinwiddie, dated 7 March 1989, which contains his handwritten addition in the third paragraph?
A Yes.
Q If you go into the next tab there are the notes relating to this admission and the next tab relates to the discharge note relating to the admission. Again, I am not going to take you into the detail. We have looked at it I think in sufficient detail for my purposes. My question here is this: Did you see Mrs H during the course of that admission in September?
A I cannot remember, but I cannot also see anything in the notes to suggest that I did.
Q Do you now have any memory of any conversation that you might have had with her about the future care of the child during this admission?
A I cannot remember.
Q If you look at tab ©, at the discharge summary, Dr Bush, your registrar, describes how overnight monitoring was carried out, which was normal, and there was a plan to re-admit when he was actually having cyanotic episodes to repeat recordings. Can you just help the Panel about that? Where was it anticipated that he might be having cyanotic episodes?
A According to the history, he had been having at home, and frequently, and yet during the recording period none occurred, and I think the message was coming back that he was going through a good patch. That is why he did not have any.
Q So?
A So the plan would be for him to come back again when he was not having a good patch and having frequent episodes, so that we could record them and find out what they were due to.
Q If we go then to the next admission which we do have to look at, the in-patient notes are at tab (d) in C1, tab 2, the last tab. Is any of that writing your writing?
A No.
Q I am looking now at all five pages. Any there of yours?
A None at all, no.
Q We move into the next volume, C2. If you look at (f) in C2 – and again I will take this quickly because you looked at it this morning – was the sleep study performed in March 1990 normal?
A Yes, it was.
Q Is the discharge note at the next tab, tab (g)?
A Yes, it is.
Q Dr Bush again, and in tab (g) on the second page, the result summarised there?
A Yes.
Q “Follow up will be by Dr Southall’s department.” Yes? Is that the result of that?
A Yes, it is. That is correct.
Q During the 1990 admission, first of all, do you see – I think I have asked you – any written evidence that you actually saw her?
A There is not any in the medical records.
Q She gave evidence to the effect, firstly, that she did not see you in March 1990 and that there was a conversation with Dr Samuels where the message was that you, in effect, could not see her because you were doing a Sky Television appearance, or words to that effect?
A Yes, that I was too busy because I was on the television.
Q What do you say, not so much about the Sky Television point, but about the fact that she says that you could not see her?
A I accepted that. It is so long ago I cannot recall detail of meeting her, but I have met her and I knew I had met her somewhere, sometime, and I was going round and round in my head as to how and what I had said to her and how it fitted with what she said in giving evidence here. So I looked to see if I had met her by looking through all the records again.
Q This is after she had given her evidence?
A After she had given evidence, yes, and I think there is something in the evidence, in the records that I have read – in fact, I read it in the University (of whatever) Hospital, that
I had met her during that admission, that I had talked to her.
Q Just pause there for a moment and just take out C7. I am going to page 178. Keep one finger on that page and turn back to page 163. Are you at page 178?
A Yes.
Q Turn back to page 163. The document you are looking at is an affidavit sworn by
Mrs H in – I am going to call it – the Family Court?
A Yes.
Q In 1991. Again, turn to page 211 and keep your finger at page 189. You see the date when the affidavit was sworn, 24 October 1991?
A Yes, I can.
Q Go back to page 178. Had you read page 178 before?
A Yes, when we were going through the special case file. This is the special case file.
Q Before the case began?
A I must have done, yes, some time.
Q So that is page 178. Turn over to page 179.
A Yes.
Q Had you read that before?
A I had, but I had not noticed when I first read it that there is a discontinuity in pages, in the sense that there is no page 16 that is copied
Q Would you go back to page 178, page 15 at the bottom?
A Yes.
Q And go to page 179, page 17 at the bottom?
A That is right.
Q So missing page 16?
A There was a missing page 16 and this is the page I saw when I looked through the university notes.
Q After she gave evidence?
A Yes.
Q Did you look at the original notes, the original university notes?
A Yes, I think so. Yes.
Q Were you able to locate page 16?
A I was, yes.
Q Can you now produce that page please? (Copies distributed)
MR TYSON: I wonder if, for my benefit, my learned friend can identify the source of this page?
MR COONAN: It is in the note, the University (of X) notes.
THE WITNESS: And the special case file.
MR COONAN: Are the original University (of X) Hospital notes there? Are they in the buff folder you are looking at? Are those the University (of X) notes?
A No, this is a special case file.
Q In order to get to the missing page 16, where did you find that?
A In the special case file, the original special case file. It has just not been copied into the bundle.
Q So the original special case file is there and can be inspected?
A Yes.
Q Page 17, as I understand it, has just been distributed, which means we can read the blanked out passage on page 17, Dr Southall?
A Yes, that is right.
Q Can you therefore take the Panel smartly to the point that you are drawing attention to?
A On page 16, half-way down the paragraph, it says that:
“On the 15th March [Child H] was admitted and he was under the care of a
Dr Samuels … [Child H] was monitored on the 15th March and the result of the sleep study was normal.”
Then if you go over the page, it goes:
“It was then suggested by Dr Samuels that [Child H’s] tracheostomy be removed and that he be put on experimental drugs for his asthma, a subcutaneous monitor and oxygen therapy.
This concerned us …”,
and there is a paragraph there,
“and we said that we would like to discuss it with Dr Southall because it seemed to be different advice from the advice that we had already received, ie. the advice that [Child H] needed a ventilator.
We finally had a meeting with Dr Southall, but he did not appear to have a great deal of time to spend with us and so we asked if we could consult with Dr Dinwiddie.”
It is that link with the second admission that made me feel as if, yes, I had met her and that
I had recalled something that had happened.
Q Is your position now, having see that, that therefore you did meet her on the second admission?
A That is what it would appear to look like from this. I cannot remember for certain because of the lapse of time, but this suggests to me something that I thought had happened, but it is there.
MR TYSON: I am sorry to interrupt. Has this got a D number?
MR COONAN: D17. (To the witness) I am going to ask you to work on the basis that you did have contact with Mrs H during this second admission?
A Yes.
Q This is an important question and I would like you to listen very carefully. Do you yourself have any recollection of you personally discussing with her the question of care being provided by a local paediatrician?
A I have no recollection of what I discussed with her. My personal memory on this is just blank. I cannot remember that far away.
Q Leaving aside the question of care by a local paediatrician, just so I am clear about this, do you have any memory now of discussing any aspect of this child’s future care, whether it be by way of paediatric neurology, by way of drugs, by way of removal of the tracheostomy?
A I have no personal recollection of that memory. I just cannot remember that meeting and that discussion.
Q Following the discharge of Child H, we will look at it in a moment, a letter was drafted to Dr Dinwiddie.
A Yes.
Q Either that day, or very shortly before, Mrs H has told the Panel that she telephoned you personally. Do you have any recollection now of any such phone call?
A No.
Q Again, so we are dotting every “I” and crossing every “T”, do you have any recollection of her saying to you, recollection now that is, of her saying to you that she was not disposed to accept the Brompton regime but was going to follow the Great Ormond Street regime?
A I recall that is what the ballpark picture was, but I cannot recall the conversation with her in which that was stated.
Q She complains, as you are well aware having heard the evidence, that in that telephone call you slammed the phone down.
A Yes.
Q Did you?
A I do not slam the phone down on parents or patients. That is not something I would do.
Q Did you have any child protection concerns about this child by 15 March, which was the date of discharge?
A Yes, I did.
Q Did you have those concerns by the time you drafted that letter to Dr Dinwiddie, which we will look at in a minute?
A Yes, I did. Not just me, the team did, and in particular Martin Samuels and I, I am sure we discussed this quite seriously because of the concerns we had.
Q Before we look at the letter, do you have any recollection of the degree to which, if any, there was a divergence between the Dinwiddie/Great Ormond Street proposal for treatment and yours?
A There was a divergence between the two hospitals, the two units, although I think that Dr Dinwiddie was very concerned about the possibly of Munchausen’s syndrome by proxy himself (he and his team were concerned), but my understanding is he did not want to lose the contact that he had with Mrs H, which was the one, if you like, consistent medical contact that there was with this family, and so I think he went along with the concept of the ventilator, and I completely understand why, because the danger would be that if he went completely in the direction I was going, she might walk away and go somewhere else, and then you would lose the contact that you had with the family, which would be potentially problematic for the family, for the child. Is that what you mean?
Q Let us come to the letter. You will find that, Dr Southall, at C2, and just so that you have your bearings there is a document which you may have to look at which is on the previous tab at (h). Let us look at the letter first, please. This letter is written primarily to
Dr Dinwiddie, is that right?
A Yes, it is.
Q Although on the second page we can see it is copied, on the face of it, to three people.
A Yes.
Q The big question is this: why did you send that letter to Dr Dinwiddie?
A He was the referring hospital paediatrician.
Q I want to take you to the last paragraph on the first page, page 23. You see the phraseology that you used?
A Yes.
Q “Our suggestion to that was that firstly”, and then the various ingredients of that.
A Yes.
Q When you used the phrase “Our suggestion”, in what sense are you using that in that letter?
A The team’s suggestion, in particular Martin Samuels’ and my own suggestion; we were the main medical part of the team.
Q Do you remember now Martin Samuels discussing this case with you before the letter was written?
A No.
Q Do you have a view now as to whether or not you think you may have done?
A There are several possibilities. I have looked through this material trying to work out all this time ago, sixteen years ago, what actually happened, and I cannot remember. There are several possibilities.
Q Which are?
A One, that he and I talked to the parents together, and that he made these notes both before and during that.
Q Sorry, which notes?
A These handwritten ones.
Q Yes.
A That is one possibility. The second possibility is that he put these notes together after reviewing everything in the records and thinking about it and then shared it with me, and then did I or did I not share it with the parents? I cannot be one hundred per cent sure. I can only say what we discussed a few minutes ago: I think I did, but I cannot be sure. What I am sure of is that these notes form the basis of this letter.
Q When you say “these notes” you are referring to tab (h), is that right?
A Yes, the notes by---
Q We just need that for the transcript.
A Sorry, the notes of Martin Samuels on tab (h).
Q So let us go back to the letter, please. First of all:
“Our suggestion to them was that firstly, they use a transcutaneous PO2 monitor whenever he is asleep ….. Secondly, we felt that reversible airway obstruction is a component of his problem and that maybe nebulised budesonide would help.”
In the body of that suggestion there is an observation made by you that he might not need the tracheostomy.
A That is really the most important issue of the whole lot, because a child of this age with a tracheostomy is in great danger, in danger of sudden obstruction of this at home and complete airway obstruction.
Q The letter goes on that:
“We also feel strongly that his neurological state has not been adequately investigated. We feel that his tremor and ataxia could go along with a brainstem or posterior fossa problem ….. We also feel that it is vital that [Child H] has his overall care managed by a local paediatrician.”
Then the letter goes on:
“We put this regime to the parents last week and they initially said that they would like to accept it.”
Now, two points arising from that. When you wrote this letter, what were you referring to when you used the phrase “this regime”?
A The previous paragraph.
Q “We put this regime to the parents last week and they initially said that they would like to accept it.”
Where do you think you got that information from?
A Well, reading that sentence, it suggests that we met the parents, presumably during the admission, and put it to them, which is why I went back to try and find some evidence that that had happened.
Q You go on:
“…they initially said that they would like to accept it. We therefore spent 24 hours training them in the use of the monitor.”
That is the home monitor, is it?
A Yes, the home oxygen monitor.
Q “They were discharged with this (the monitor) on Friday night of last week.”
Then this:
“In communication with them today, they have decided to reject this advice and go for the triggered ventilator approach. They are therefore returning the TCPO2 monitor to us”.
The phrase in that letter “In communication with them today”, is that a reference, I ask for your view, to the telephone call that the Panel heard about?
A It sounds like it.
Q Now, what was your state of mind, Dr Southall, looking at this letter and trying to jog your memory by that means, what was your state of mind therefore following the telephone call or communication, as you have described it there?
A The fact that the parents were rejecting the approach that we were offering was further evidence to me, or us, that we were on the right track that there was not going to be cooperation in trying to close the tracheostomy to unravel the real problem in the child.
Q In the last paragraph you say:
“Martin Samuels and I both feel that these parents are not acting in the best interests of [Child H’s] long term future.”
The next two lines I invite the Panel to follow themselves, and then you take it up in this way:
“I have left it with the parents that should they change their mind we are here and willing to implement the approach outlined above.”
There are two points there, please, Dr Southall. When you say in that letter dated 22 March 1990 that you left it with the parents that should they change their mind, et cetera, et cetera, can you help in the construction or otherwise how and when it was so left with the parents?
A Well, it must have been in the telephone communication, and the way it is written it is not really compatible with me putting the phone down on them because I was angry. It does not make sense. I would not have put the phone down on them anyway, I have already said that, but it just does not fit with that. It fits more with the possibility that they might come back to us, or perhaps that Dr Dinwiddie might persuade them to come back.
Q So the letter was written, as you have said, primarily to Dr Dinwiddie. I want now to deal with the copying. Why was the letter copied to Dr Bailey?
A Because he was the child’s GP.
Q Would there have been a covering letter when this is copied to Dr Bailey?
A No. There could have been, but there would not usually be.
Q Why was this intended to be copied to Dr Weaver?
A Because we knew that she had at some time in the past been involved with Child H and that she was a local paediatrician in a university hospital near where he lived. I mean, the real issue was that here was a child having multiple, up to forty times a night, blue attacks requiring resuscitation, who was not attending any local hospital at the time. He was only engaged through his parents with Great Ormond Street, which is 130 miles away. We heard from the mother that he was needing resuscitation and they were calling the ambulance. Here is a child with a tracheostomy that could at any time completely close, obstruct his airway. We felt that local hospital doctors should know about him. That is why Dr Weaver was listed, because the hospital we are talking about that she worked in was not that far from where they lived. In strict terms I do not think it was the local district general hospital, it was a university hospital, but it was reasonably close.
Q Was there a covering letter to her?
A No.
Q Particularly in relation to her, do you think it was appropriate or inappropriate that there was no covering letter to her?
A She had already been involved. I think it was reasonable for there not to be a covering letter. She would know Child H’s problem.
Q The third person copied into this on the face of it was the consultant, or a consultant paediatrician at Gwent. I think it is unavoidable to use some of these geographical terms, speaking for myself, but remember the warning.
A I do understand. It is quite difficult with this case.
Q This happened in 1990. First of all, do you know as a matter of fact whether this letter was ever sent to the Royal Gwent Hospital?
A I do not know.
Q Do you know whether, as a matter of fact, it was sent to an unidentified consultant paediatrician?
A That is not ideal, if it was sent.
Q Do you know whether or not it was?
A I do not. I do not know what happened.
Q When you say it is not ideal, can you therefore deal with that? Why not?
A I agree with Professor David on this, that if it had been sent to a local paediatrician who had not, up until that time, been involved with the child, then it would be quite a shock, if nothing else, to receive such a letter without a preceding telephone call or a covering letter.
Q Have you any memory of a telephone call being made, now?
A No, I have no memory.
Q Can you help one way or the other as to whether a covering letter was sent?
A I think if a covering letter had been sent, it would have been there.
Q You described Item 3 as simply the consultant paediatrician, Royal Gwent Hospital. Knowing your secretary as you did at that time, can you help the Panel as to what her instructions would be simply reading that?
A She was really good, the secretary I had at the Brompton Hospital, I mean really bright. She went on to university. She was very smart. I am sure she would have discussed it with me. It may be that this was the first draft of the letters that went out. Who knows?
I can give all sorts of excuses, none of which would be anything but that, because I cannot remember what happened with that.
Q Insofar as the letter was sent – let us work on this basis, that it was sent to the Royal Gwent Hospital, whether it was to an unidentified or identified paediatrician – what would have been the overriding purpose for doing it?
A There are two reasons here for sending such a letter, both to Dr Weaver and to a paediatrician at Gwent. The first and most important is the issue of the tracheostomy. A child with a tracheostomy of this age having multiple episodes of resuscitation being unknown to the local hospital is unacceptable medical practice. It would have been totally wrong if I had not notified at least one of them. The second reason is the child protection reason. Again there were real concerns, as shown by what later happened in this case, about why they needed to know about the child protection concerns. So there were two reasons. The first is the most important. The second is still important.
Q Did you get consent from the parents before you sent this letter? Let us assume that it was in fact sent. Did you get consent before sending it or intending to send it?
A Because of the nature of the content of this letter, to have got consent – I agree with Professor David – I would have had to have shown it to them first. It is no use me saying to them, “I am going to write to your local doctor/consultant about this” and not say what is in it. At that time I had not broached with the parents my child protection concerns. So if I had done that, if I had broached that with them, there could have been some adverse consequences, I think. It is the kind of material that you would not necessarily wish to distribute widely until you had got further down the chain.
Q Sorry, two questions. First, did you in fact take consent?
A That is what I was coming to. No, I did not.
Q Do you think you were right or wrong in not seeking consent?
A I think I was right in not seeking consent with regard to the child protection bit.
I could have sought consent over the issue of the tracheostomy and I may have done for all
I can recall. I could have said to her, “I am going to notify your local hospital because they need to know about this tracheostomy”, in fact I think I probably did. But I definitely would not have said, “I am going to notify them about the child protection concerns”. I would not have done that.
Q Dr Southall, just to deal with one aspect of Professor David’s evidence, when he highlighted one potential purpose of this letter being, as it were, to invite a local paediatrician to take over the management. Was that the purpose of this letter?
A No, not to take over the management; to be aware of the presence of the child in the area with a tracheostomy and to be aware of the child protection concerns.
Q In terms of geography, you spelt out Dr Weaver’s hospital in relation to the parents’ home. Can you help about the vicinity of the Royal Gwent hospital to their home?
A I think at the time I thought their local hospital was the Royal Gwent, I must say.
I thought the University Hospital of Wales was involved, but more distant from where they lived. I have realised since from Dr Weaver’s letter that it was on the border, according to her letter.
THE CHAIRMAN: Mr Coonan, when you reach a suitable point, perhaps we can take a short afternoon break.
MR COONAN: I can break now, madam.
THE CHAIRMAN: Then we will take a 15-minute break now.
(The Panel adjourned for a short time)
MR COONAN: Dr Southall, the letter we were looking at dated 22 March 1990, identifies in effect two hospitals, both in Wales. I want you now please to take C7 and go to page 91. This is just for the purposes of identifying the document. It is page 91 and this tells us that these are minutes of a case conference in 1991, which is over a year later.
A Yes.
Q For my purposes I want to move on to page 105. We see a conclusion of the case conference,
“not to be shared with Mr and Mrs H. [Name given] Hospital Casualty Department and Royal Gwent Hospital to be alerted to this case in case Mr and Mrs H may try to present H elsewhere than to the hospitals already involved in his care”.
Can you remember the thinking behind this?
A I just want to see whether this was before or after the tracheostomy had been closed.
Q Can we come to that in a moment?
A It is just trying to think about the logic behind this.
Q We can take time to look at these in a minute. For my limited purposes, with your assistance I want to identify the fact that another hospital has now made an appearance. Right?
A Yes.
Q Having done that, I am now going to ask you to produce, just so the Panel can get a feel for the geography, a map with the identification of those hospitals and the home address. (Document distributed) Madam, this will be D18. Dr Southall, you will see that this is an extract from a road map. The red arrows, there are four of them, are you in a position to identify what they refer to?
A Yes, I am.
Q Can you help? Take the one on the right hand side. What does that refer to?
A The Royal Gwent Hospital.
Q The one in the middle?
A I am not sure about that, but I suspect that is the Caerphilly Hospital.
Q The one above that, going anti-clockwise, near the village beginning with B?
A That is probably where they live.
Q That was the name of the village on the address, was it not?
A Yes.
Q The next one down, going anti-clockwise?
A The next one is the Caerphilly Hospital again.
Q Finally, anti-clockwise?
A That is the University Hospital.
Q Dr Weaver.
A Yes.
Q Following the letter that you wrote on 22 March to Dr Dinwiddie, which was copied to various people, there are a couple of letters from Dr Weaver I would like to ask your opinion about. But first of all this, which I forgot to ask you before the break. Do you know how many consultant paediatricians there were in Gwent at that time?
A No, I do not.
Q Can you now turn to C2 at tab (o)? Did you get a reply from Dr Weaver in response to the copy being sent to her with a letter to Dr Dinwiddie?
A Yes, I did.
Q In the first paragraph Dr Weaver says this – last few lines –
“I imagine that the parents have involved yet another paediatrician in H’s care – there are now three district health authorities who have some involvement with them”.
What would you like to say about that?
A That is not correct. I do not think the parents had involved another paediatrician. It was an interpretation that Dr Weaver had made about my letter.
Q Then on the next page, still in the same tab, the following day, Dr Weaver writes to Mr and Mrs H.
A Yes.
Q I do not think this was copied to you. If I am wrong I will be corrected, so I will confine myself to asking just for a comment on this correspondence between Dr Weaver and Mr and Mrs H. Is there anything you would like to say about that?
A It points out that where they live is on the border between district health authorities, so that either hospital was appropriate.
Q Is that consistent or inconsistent with your approach as per the letter of 22 March?
A It is consistent with that, and also she is offering to see H again. In the first paragraph she is offering to see him again.
Q Again, I should ask you formally about that. Is that consistent or inconsistent with your hopes and aspirations for this child?
A I think this was a good thing, because this was what I was trying to achieve, a local hospital being involved with his care.
Q We have to go back now to C7 and look at the last four letters. Can you start at page 50? This follows the sequence of correspondence and we are now at 17 April. This is you writing to Dr Weaver,
“Thank you for writing to me following my latest letter concerning this family”.
Then you go on to deal with the dealings you have had with the company which manufactures ventilators. I draw your attention to the last paragraph. Obviously we can all read what is said there, but can you, in a word or two, summarise, please, your thinking and what it is that is going on at this time?
A Despite us telling the parents that we could find no problem with the breathing of Child H, his breathing was normal, he had no evidence of a disease that required a ventilator when he was asleep -- the disease that we discussed being congenital alveolar hypo-ventilation syndrome, the parents were pursuing a ventilator company to sell them directly, using money they had raised, a ventilator.
Q What was your view about that?
A This further consolidated our views that particularly the mother was pursuing diseases that did not exist; that is to say, that this was an example of Munchausen’s syndrome by proxy, of a serious kind.
Q Can you turn to page 51? This is Dr Weaver to Mr and Mrs H again, dated 9 May, copied to you:
“Child H was on my outpatient list this morning but it is always possible that you did not receive the appointment. I am sending another one therefore because it is important that a paediatrician locally sees Child H from time to time”.
The rest of the paragraph I do not go into detail about, but simply the first few lines there. What is your comment about that, Dr Southall?
A It shows how appropriate, in my opinion, Dr Weaver was being about this case. It is clear that Child H had not been brought to her outpatient appointment, so she wrote straight to the parents, pushing them to do so, again reinforcing the point that a local paediatrician should be involved with Child H.
Q On the right hand side there is a significant quantity of handwriting. Is that your writing?
A Yes, it is.
Q Read out the writing, forget the initials.
A “Good. Dr Weaver is going to pursue this to its appropriate end, I hope”.
Q Exclamation mark.
A Yes, exclamation mark.
Q Then page 52 is a letter from you to Dr Weaver on 4 June 1990. It is copied to
Dr Dinwiddie and you refer to a recent article in a magazine. Again, can you in a word or two help the Panel, please, as to what prompted you to write this letter in those terms to
Dr Weaver?
A One of the characteristics of parents in this situation is that they gain a lot of attention from their child’s “illness”, and in doing so quite often are involved with the media, with raising money for their child and in this case trying to purchase from locally raised funds a ventilator that he did not need. I think at this stage I was pushing Dr Weaver to go ahead with a case conference; that is, to actually formalise the child protection concerns.
Q Dr Southall, at that stage, certainly 1990, were there any dangers associated with the use of a ventilator in a home setting?
A Enormous dangers.
Q Can you spell them out please?
A First of all, he still has the tracheostomy at this stage, which in itself is dangerous, but when you start attaching a tracheostomy to a ventilator you have no protection from the airway – upper airway – so if things go wrong with the ventilator, the pressure goes up too high, you can burst the lungs. That would be really extremely dangerous. The ventilator would also, could also damage the lung, the lining of the lung, if it is not used properly. It also can introduce infection. There are lots of problems with it.
Q I want to ask you please to look at the last of the letters, page 53 in C7. This is
Dr Weaver to you, dated 6 June. She acknowledges your letter to her where you referred to a particular magazine. Is that right?
A Yes, that is right.
Q She writes to you:
“I have almost lost sleep over this little boy and the problems, but have not succeeded in seeing him with his parents though I have tried a few times by writing to them to see him in my clinic.”
The last paragraph she says:
“Secondly, there is a very real fear that if we become involved in too high a profile along the lines that both you and I are thinking of, that something really will happen to [Child H], that is that he is more at risk if we attempt confrontation or opposition to his mother’s pathological behaviour than if we quietly go along with it. However, having read your latest letter I really will see what we ought to be doing and I will involve Social Services in a more formal way, which I have not done up to now.”
There is then some handwriting added. Just in a word Dr Southall, when you received this letter from Dr Weaver did you agree or disagree with its sentiments?
A There is a lot of concepts in that paragraph; it is not just one or two. She is raising numbers of issues. One is that what do you do when you are in this situation? Do you confront the situation, because it can be dangerous if you confront it in the wrong way. That is one of the concepts that she is raising. She is saying, well, should we go along with it, and again she is partially rejecting that because she does not know how to handle it. I think that this was fairly early on in the management of this difficult condition and she just does not know what the right path is, and the right path is complicated because if you make a mistake she would be worried, for instance, that it could push the parent to demonstrate to the world that there really is something terribly wrong with the child in the breathing angle, which is what she is talking about here. So it had to be handled very carefully and that is, hopefully, what happened next.
Q I think I can deal with the next part of this quite shortly, simply to identify the sources. Following that correspondence which continued for a time, and the Panel can see the rest of it in the bundle, did you summarise the position at page 72 in a medical report dated 27 June 1991, so just over a year later. Is that right?
A Yes. The situation was that Dr Weaver was finding it very, very difficult to know how to take this forward, and so we in the end decided, through the Royal Brompton Social Services Department, to seek a strategy planning meeting as to how we would take this forward. Then I was requested to provide a report, which is this one, which went to the Family Court, basically.
Q We have looked at this in a slightly different context, but did you attend a case conference on 10 July, shortly after this report, and we can pick it up at page 91?
A Yes.
Q It runs from page 91 to page 105, Dr Southall?
A Yes.
Q Within those minutes of the case conference – and I draw the Panel’s attention to this, because I am not going to take you through this – you, Dr Dinwiddie and Dr Weaver have their opinions recorded?
A Yes.
Q Have you looked through these minutes?
A Yes, I have.
Q Are you satisfied that they are accurate in so far as they relate to what you had to say?
A Yes, they are accurate.
Q I am going to pause as of that time, July 1991, and just come back to the major question in respect of heads 7, 8 and 9. Both at the time when the letter of 22 March 1990 was written and at July 1991, do you feel that the writing of that letter in those terms to each of the three people copied was justified or unjustified?
A I think that it is totally justified with regard to the GP and Dr Weaver, and of course Dr Dinwiddie. As far as the unnamed paediatrician is concerned, it is not optimal to have sent such a letter without first having the name of the consultant and/or talking to that person. Whether I did or not I cannot recall.
Q But for those two, as it were, potential self-criticisms of that process, but for those two, is it your view or not that the letter, if it was sent to the Royal Gwent, was justified or not?
A It was justified, definitely.
MR COONAN: That is all I am going to ask you about Child H. Now I am going to turn to the last case, which is Mrs M. Madam, I am looking at the time. I personally am content to continue. I just raise two matters. First of all, Dr Southall has been in the witness box all day long. I am now about to embark upon an important matter. It will take a little time; I will not finish by 5 o’clock. I am in your hands.
THE CHAIRMAN: Mr Coonan, perhaps I can bounce that back to you. I think the Panel is prepared to sit until the nominal time of 5 o’clock. Perhaps you are in a better position than us to know whether you feel it is in the best interests of proper conduct to carry on – maybe you know how Dr Southall feels – or whether it is going to prejudice you putting your case if we carry on.
MR COONAN: One possible way I can only suggest to you is whether you were to ask Dr Southall directly whether he is content to sit until 5 o’clock. I know it puts the burden on him, but I do not think I am in a position to take a view myself.
THE CHAIRMAN: Dr Southall, you have heard that exchange. We are very conscious of the fact that you have been giving evidence for a long time. Could you give us an honest view as to whether you feel able to continue for a short time?
THE WITNESS: Yes, thank you for that opportunity. I actually am tired, I have to admit it, and I think this is one of the most important issues, so I do not want to be addressing it feeling quite tired. It is important to get it right. Ideally, I would like to leave it till tomorrow. I am happy to go ahead now if you want, but I would ideally like to leave it till tomorrow.
THE CHAIRMAN: Having heard you say that, I see the Panel all concurring that we would wish that you can give that evidence when you feel fresh. Is that appropriate then,
Mr Coonan?
MR COONAN: Certainly, madam. Yes.
THE CHAIRMAN: We will now rise until 9.30 tomorrow. I have to give you the warning about not speaking to anybody overnight.
THE WITNESS: Thank you very much for that.
(The Panel adjourned until 9.30 a.m. on Tuesday, 28 November 2006)