This seems very rigid. We were involved in a fairly similar case last year.
A 12 year old boy from a low income family was put on the register after
being seen with widespread bruising for which there was no very good
explanation. No investigations appear to have been done and I think the
route of reporting was neighbour>>NSPCC>>social services. The boy then
developed nephrotic syndrome and a vasculitic rash and was found to have
SLE with thrombocytopaenia. SLE is vanishingly rare of course but a FBC
would have saved the family a lot of grief.
Lesley Kay
-----Original Message-----
From: Rob Johnson [SMTP:[log in to unmask]]
Sent: Wednesday, November 25, 1998 12:51 PM
To: [log in to unmask]
Subject: Re: Child Abuse - A complaint
In article <[log in to unmask]>, Rob Johnson
<[log in to unmask]> writes
>The Question I really need a consensus about is " What is the definition
>of the word likely" in the above sentence.
My thanks to the 10 people who responded to this question. I had hoped for
a larger response but the replies did demonstrate to me that this is not
such a strait forward question as I had perceived.
My rational is that if you use the word 'likely' to describe an event then
the opposite would be unlikely and there is nothing in between. Thus I
would argue that for an event to be likely there must be a probability of
>50%. This argument was not accepted by Social services and I had hoped to
present a medical consensus from this group. 2 people supported my view
but the others all started at a much lower level. The lowest being >5%.
The case in question was about a child who sustained a fracture that
occurred with minimal trauma and with an explanation that was accepted by
the Hospital. The skeletal survey showed a periostial reaction in another
long bone. There was a lot of debate as to whether this was a normal
finding or an indicator of another fracture. 10 days later, after further
x-rays and various discussions, it was finally concluded that it was almost
certainly another fracture. A S47 investigation was held by social
services and came up with nothing of concern. The parents were very
distressed that the "Professionals" believed that they had abused their
child and asked the Paediatricians if there could be a Medical explanation.
Their question fell of deaf ears. Knowing that they had not caused the
fractures they went in search of an explanation. The baby had very obvious
Blue/Grey sclera and they wondered if this was Osteogenesis Imperfecta.
The local paediatricians had failed to establish a relationship of trust
with the family and were unwilling to get involved in reassessing the
child. The family finally took the child to Scotland to see Dr Patterson
who confirmed this as a typical case of Osteogenesis Imperfecta Type 1A.
At the case conference the paediatricians advised conference that Dr
Patterson's opinion should not be accepted. (It is difficult to explain the
reasons for this without risking a libel action). It was decided that a
Paediatric assessment was needed to decide on the diagnosis and that until
that had been done then the child's name should be added to the Register
under the category of "Actual Physical Abuse". The reason they gave was
"As there is an unresolved issue, further injury is likely". This
conclusion was reached despite statements by all the people that knew the
family well, namely myself, the health visitor, the police and the school,
that they did not believe that further injury was likely.
Two weeks later after a Paediatrician from another unit had confirmed the
diagnosis of Osteogenesis Imperfecta the child's name was erased from the
Register.
I complained to Social services that the decision to register was
inappropriate and had caused the family tremendous emotional pain. My
complaint was dismissed on the grounds that "Further injury was likely"
For those of you that have got this far, I would appreciate your thoughts.
Rob.
THIS DOCUMENT IS INTENDED FOR DISCUSSION WITHIN GP-UK ONLY
Dr R I Johnson
The Family Practice, Church Lane, Sleaford, NG34 7DF
Tel. 01529 305595 Mobile 0378 206475 Fax No 01529 305589
Single handed GP. Send email to [log in to unmask]
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|