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Editor,—We were interested in the annotation on pretrial or precourt hearing liaison between doctors acting as expert witnesses in the cases of alleged child abuse.1 We agree that there is considerable utility in this approach as the following case illustrates.
A set of female triplets were initially referred to one us (DH) for review and examination following a disclosure that they had been sexually abused by their father. The children were examined by colposcopy using a standard technique of gentle labial traction.2 Still photographs of the findings were made with the informed consent of the mother who understood that they would be used for teaching and training purposes only. The examination findings were consistent with previous sexual abuse, but there was neither disclosure of, nor findings compatible with, recent trauma.
The photographs were subsequently obtained and discussed at a peer group review meeting held by North East London paediatricians who work in child protection at which we were present. There was a debate as to whether there were changes in the hymens of the triplets consistent with sexual abuse or whether the appearances were due to congenital abnormalities of the hymen. Unknown to the peer group members, one of us (JW) had been asked by the official solicitor to review the medical evidence.
To resolve these important issues it was agreed that there should be a joint medical examination by DH who described the initial findings, JW who had been asked by the official solicitor to comment on the medical report, and VL who gave an independent opinion. The mother and children gave consent. The court granted permission for the medical to be part of a “precourt” review. At the examination we agreed that in two girls the findings were diagnostic of sexual abuse and in the third strongly supportive of it. No doctor had to give evidence in court.
These cases illustrate three points. First, the utility of the peer group review; second, the difficulties that may arise when photographic or even video evidence is used; and third, the positive benefit of joint examination by experienced paediatricians. None of the girls reacted adversely to the process and we were able to discuss the findings with the family and other child protection agencies.
We believe that this case highlights the importance of pretrial liaison in child protection work and illustrates the therapeutic benefit of the joint approach.3
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