yeah yeah David, whatever; the below protocol was written for the Royal Brompton and what did you go and do eh ..... such a liar and somebody that says one thing to pacify the stupid idiots that believe your every word (cult) and does another. Do I detect a personality disorder, (psychopathic tendencies) you'd better believe it honey. You hide behind the mantra that you are brave and fearless, stating you're out there for the good of children, when the reality is, that it's all about you and your desire to be hailed as an icon because of your deep seated inadequacies and all your little "friends" worship at your alter and don't you just love it, no need it!
You can't fool me David, you never could, you fooled Panorama, you fooled PACA members, you have fooled some of the media, you, for a time, fooled your lawyers, but never me. I know you and your type.
Another little matter, you had already instigated a police investigation into Mrs M and child M1 and his death, yet you "interviewed her" potentially skewing any prosecution, you see the ins and outs of that interview were moot, you shouldn't have talked to her at all and this document proves, because it predates that interview by many years, that you knew that didn't you!
Read the above and apply it to the below.
PROTOCOL FOR THE MANAGEMENT OF INFANTS SUSPECTED OF SUFFERING OR BEING AT RISK OF SUFFERING IMPOSED APNOEA (SMOTHERING) ,
From the Paediatric Department of the Brompton Hospital Background
The accompanying manuscript (Enclosure 1), which is now in press with the British Medical journal, describes the management of two recent children who presented to the Brompton Hospital with severe hypoxaemic episodes due to smothering.
In addition to the above cases, one further newborn infant whose previous three siblings had all died suddenly and without adequate explanation and where the referring paediatrician had suspected infanticide has undergone 24 hour covert video surveillance.
It is anticipated that further cases with problems similar to those described above will be referred to our paediatric department. This document outlines a protocol for their management.
1) Management Prior to the Initiation of Covert Video-Surveillance
All infants will be fully clerked in by the junior medical .staff. The parent(s) of all patients will in addition be seen by Dr Southall and/or one of the other consultants at the time of admission. It is important that all parents are interviewed by the paediatric social worker, or her deputy, as soon as possible after admission in order to provide a social and psychological assessment of the family. The social worker will also liaise with the social service departments at the referring hospital and/or the area of domicile of the family.
Dr Southall will initiate a standard overnight recording of O2 saturation, respiratory airflow, expired CO2, EEG, and breathing movements to help rule out a natural causes for the cyanotic episodes. If an episode of apnoea occurs during this recording it might show the characteristic pattern identified in association with smothering described in detail in the enclosed manuscript.
If the circumstances of the cyanotic episodes and the above recording suggests imposed apnoea then an immediate case conference will be held at which the following representatives should be present:- a member of the hospital social work department and social services manager, Dr Southall and/or XXXXXXXXX one of the nursing sisters from Rose Gallery, one of the nursing officers, a member of the hospital administration and, as is standard procedure at a case conference, a member of the local police force. Drs Southall, XXXXXXXXXXXXXX will also notify by telephone the referring paediatrician and the child's family practitioner about the reasons for holding a case conference. Although they will be invited to attend, this is unlikely to be possible for them given the urgency of reaching a decision concerning the video-surveillance. During this meeting the need for a Place of Safety order would be considered and subsequently initiated by the police or social services department as agreed at the meeting. Dr Southall or one of the consultant paediatricians will contact the Chelsea police station and, request their help in establishing the video surveillance.
2) Management of the Video-Surveillance
One of the cubicles in Rose Gallery, preferably the one closest to the sister's office, will be used for this surveillance. The infant/child will be attached to a tape recorder collecting the following physiological signals; (O2 saturation, breathing movements, and respiratory airflow) thus tethering the child within the field of vision of the camera.
The camera will be situated in the ceiling of this cubicle and connected to monitoring and video recording equipment in a cubicle on Gallery 3 (the ward above Rose Gallery). The video monitor will be surveyed continuously by police officers based on Gallery 3. These police officers will not enter the children's ward except when setting up the equipment. The police officers will have an emergency radio transmitter which will be linked to a radio receiver carried by paediatric nurse on Rose Gallery who has volunteered look after infant.
If the police officer detects an episode of smothering or suspected smothering he/she will wait 10 seconds for corroboration and then alert the paediatric nurse by radio. The nurse will immediately go into the cubicle and attend to the infant. The nurse will not confront the mother but merely check that the child is breathing and thereafter remain in the cubicle.
The police officer will also alert Dr Southall or a designated member of the medical staff. Dr Southall or deputy will then proceed immediately to the cubicle on Rose Gallery and request the mother to accompany him to Gallery 3. The mother will then be introduced to the police officers. Dr Southall will not discuss the reason for this transfer of the mother from the children's ward unless it is absolutely essential. He will not discuss the video monitoring since this could prejudice any subsequent court proceedings brought by the police against the mother.
If statutory protection is required, this will follow. The paediatric social worker or deputy will liaise with the family's local social service department to arrange for transfer of the child out of the hospital provided that the medical staff are satisfied that he or she is healthy and has no need for further investigations or treatment.
Dr Southall, or deputy, will contact the paediatrician or family practitioner who has direct primary care of the family requesting that she or she inform in
person the husband, father or guardian of the child about the diagnosis and police action.
Justification for the Protocol and Ethical Considerations
In a publication entitled 'A Child in Trust' concerning the death by physical abuse of a child called Jasmine Beckford the following statements are stated relevant to our action.
“.... the immediate treatment and care of an abused child is essential . The need for accurate factual information is paramount in all cases as it is often the absence of concisely documented information which leads to unnecessary difficulties."
"....parental rights cannot be insisted upon by a parent who has abused these rights."
Further discussions on these vital issues are to be found on pages 16-19 of Enclosure 1 and in Enclosure 2, which is a report by Professor Dunstan following a meeting at the Brompton Hospital to discuss the ethical problems associated with this approach to the management of this serious and dangerous form of child abuse.
There are two further questions that should be answered.
1. Does the covert video surveillance need to be implemented by the police?
We consider for the following reasons that this is essential. The medical, nursing and social service professions have no training in detective work, in handling people suspected of committing criminal offences or in the use of covert video surveillance. The need to obtain hard, unequivocal evidence has been discussed above. It is possible that evidence obtained without the help of the police may be inadmissible in court. It is crucial that if the child is being abused he or she is adequately protected from further injury. Only the court has sufficient power to enforce this. It is also vital that the abuser receives psychiatric treatment and once again only the court has the power to enforce this. Although we accept superficially that enlisting police assistance may be considered to promote a punitive outcome, this is in fact incorrect. The police act only to protect the public. It is the juries and judges, who are elected on behalf of society, who provide, hopefully in an appropriate way,either punishment or treatment to the abuser.. In all three cases to date investigated at this hospital we have been impressed by the professionalism and compassion shown by the police. For these reasons although it would not be illegal to do so, we do not wish to manage covert video surveillance without the help of the police.
2. Would the pattern of signals on the multichannel recordings be sufficiently specific for imposed apnoea and therefore avoid the need for video surveillance?
Unfortunately this hypothesis will have to be tested prospectively on a larger number of cases before it could be scientifically or legally accepted and therefore this investigation cannot be used without the video surveillance.
Finally we stress that information with respect to suspected or proven child abuse is absolutely confidential and must be discussed only with personnel involved directly in the care of the child or his or her family. This protocol will be implemented by, and involve only medical, nursing or social service personnel who have agreed to abide by this agreement on confidentiality.
