The Baby P case has highlighted the need for awareness among student radiographers in identifying potential abuse victims.
Last month, the NHS came under fire when health watchdog, the Care Quality Commission Radiographers, issued its report on the tragic case.
Radiographers were amongst those criticised for 'systemic failings' in the care given to Baby P, before his death.
Health professionals at North Middlesex University Hospital NHS Trust and Haringey Teaching Primary Care Trust had contact with Baby P (who can now be named as Peter) 35 times in his short life. Every opportunity to raise the alarm and save him was missed, the commission found.
The report stated that any one of the professionals could have picked up that he was suffering abuse if they had been vigilant and gone beyond what was required.
It examined the actions of four NHS trusts in London: North Middlesex University Hospital NHS Trust; Haringey Teaching Primary Care Trust; Great Ormond Street Hospital for Children NHS Trust and Whittington Hospital NHS Trust.
All had been involved in Baby Peter's care before his death in August 2007 aged 17 months. Investigators found a 'catalogue of errors', including:
* Chronic staff shortages;
* Inadequate training;
* Long delays in seeing the child, and
* Poor communication between health professionals, police and social services.
They highlighted a series of failings when consultant paediatrician Dr Sabah Al-Zayyat saw Baby P at St Ann's Hospital in Tottenham, north London, two days before he died.
Dr Al-Zayyat decided she could not carry out a full check-up because the little boy was 'miserable and cranky' and did not spot that he had serious injuries, probably including a broken back and fractured ribs.
The doctor had no contact with Baby Peter's social worker before or after the appointment and was given no details about the child's previous hospital admissions, the commission noted. She was one of only two consultants at the children's clinic at St Ann's Hospital, when there should have been four.
The report also shows that several months before, on 21 December 2006, Baby Peter attended Whittington Hospital paediatric day unit as an outpatient where an x-ray was taken. The images were described as 'not good' and a repeat was planned in the new year. On 17 January 2007 another x-ray was taken, but no abnormality was seen. The film, however, was described as 'poor quality'.
The third and final time Baby Peter underwent imaging was on 9 April 2007 when he his mother took him to A&E at North Middlesex University Hospital. He was admitted for observation due to post head injury and underwent a CT head scan, which was normal. There were bruises and scratches on his face, head and body.
Two days later, Baby Peter was discharged from the hospital without a formal meeting to discuss concerns about possible abuse - contrary to standard procedures.
Baby Peter died less than four months later on 3 August 2007. The post mortem revealed further injuries: a tooth was found in his colon and eight fractured ribs on the left side and a fractured spine were detected. The provisional cause of death was described as a fracture/dislocation of the thoracolumbar spine.
Cynthia Bower, CQC CEO said the tragedy occurred because of system failures rather than individual culpability by the health workers who saw Baby P but added: "If somebody had been particularly vigilant and gone beyond their scope, beyond what was required, any one of those could have picked it up."
Students: Stay vigilant
Audrey Paterson, director of professional policy at the SoR, reiterated this point, commenting: "No member of the radiography team can have been unaffected by the dreadful nature of Baby Peter’s death, the catalogue of abuse during his short life and the shortcomings of organisations and professionals who could have made the difference but for Peter’s death to change how we practice we need to be ‘particularly vigilant’ at all times and act if we are concerned or if our suspicions are raised."
"Students are part of the front line when it comes to identifying potential abuse victims; they should not be scared by this story but they do need to remain aware."
Support and guidance
Prof Paterson pointed to the following guidance available to install confidence in students that they can act appropriately if they suspect a case of child abuse:
The SoR is to publish a new document for radiographers 'Practice Standards for the Imaging of Children and Young People' later this year.
Three existing documents are already available on the SoR online document library:
• Guidance for Radiographers Providing Forensic Radiography Services 2008
• The Child & the Law: The Roles & Responsibilities of the Radiographer 2005
• Skeletal Survey for Suspected NAI, SIDS and SUDI: Guidance for Radiographers 2009
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