“1. The judge erred in making the finding of sexual abuse, when Dr Rahman had stated that anal dilatation could occur in children who had not been sexually abused. The presence of genital warts influenced both treating and expert Doctors, which was on the understanding that the Mother had not had genital warts. However, based upon the medical evidence that came in after the experts had given that evidence, the judge accepted that genital warts could have been passed from the Mother.”
“An appeal from this fact-finding decision would not have a real prospect of success. This court could only intervene if it found that there had been a failure to consider the whole of the evidence in a rational manner. In fact, the judgment shows that the recorder approached her task with considerable care and reached conclusions that were clearly open to her on the evidence. The grounds of appeal, amplified in various respects in the skeleton argument, are not persuasive. The threshold was plainly crossed in this case. The finding that [ZY] has experienced sexual abuse was securely based on the medical evidence, taken in the context of the evidence as a whole. The consequential conclusion that the applicant is one of the individuals who may have perpetrated the abuse was founded on the court’s assessment of the evidence, including her own evidence. The recorder adequately explained why, at the same time as making serious findings of domestic abuse against the Father, she did not include him in the pool of perpetrators of sexual abuse. That was a judgement for her to make and this court would not disturb it. Finally, the judgment contains a sufficiently balanced account of the relevant factors, including those favourable to the applicant, for it not to be susceptible to an appeal. Permission to appeal is therefore refused.”
“UPON the Court informing the parties that for the sake of transparency, the Court has made enquiries with all Designated Family Judges on the Midland Circuit as to whether they were aware of any Judicial concerns relating to SARC NUH, and upon being informed by HHJ Reece of a judgment, wherein criticism was made of SARC NUH on the basis of a report prepared by Dr Wendy Gray. The Court confirming that it will obtain and provide to the parties and the intervenor the relevant excerpts, suitably anonymised, of criticisms and observations, in their proper context. AND UPON the Court informing the parties that it will obtain Dr Gray’s report and provide a suitably anonymised copy to the parties. AND UPON the Court stating that if there are any objections from the parties in the case of His Honour Judge Reece, the Court shall deal with this administratively and if necessary, requiring only written submissions from the parties. AND UPON the Court being concerned about rumours on the Midland Circuit in respect of SARC NUH and wishing to resolve matters on a factual basis AND UPON the Court as a consequence, inviting the advocates to make all reasonable enquiries with other Counsel, and if considered appropriate, Dr Wendy Gray, to identify any other case that may involve judicial criticism of SARC NUH AND UPON the Court confirming that Counsel should refer details of such cases directly to Mrs Justice Lieven via email to her clerk: AND UPON the local authority informing the Court that it was not currently aware of any other case with concerns in respect of SARC NUH, save for the matter before HHJ Weston KC in which the local authority were granted permission to withdraw proceedings and no judgment was given.”
“When an application is made to reopen findings of fact in a family case the court proceeds in three stages…”
“… the court will need to be satisfied that the challenged finding has actual or potential significance: it is likely to make a significant legal or practical difference to the arrangements that are to be made for these or other children.”
“5. The first respondent Mother has been dishonest with professionals in respect of the following: a) her relationship with [EX], the date when he met the children and his involvement with the children’s personal care; b) the individuals who were involved with the children, including whether the Mother had other relationships, and; c) the extent of her knowledge as to the risk posed by the children’s maternal great grandfather who is a convicted sex offender, and the children’s contact with him 6. The first respondent Mother has been dishonest with professionals in respect of her sexual health status, withholding the fact that she was treated for genital warts (which the Mother knew to be genital warts) in November and December of 2020 which prevented professionals from gaining the full forensic picture in respect of the children.”
“a. “Coming now to the Mother’s evidence, I am afraid to say at the outset that there were significant portions of the Mother’s evidence which were largely unsatisfactory. There are numerous points of her evidence which are inconsistent both internally and when one considers her account against the documentary evidence in this case. The Mother gave evidence twice as I have already outlined. I will deal with some of her evidence in my analysis shortly. There are some key areas however which I will mention here. I do not have time in my judgment to recount how many inconsistencies there were in the Mother’s evidence and her account because, put frankly, there are too many.” [J121] b. “Two appointments concern me specifically. On1 February 2021 , the Mother said she would book an appointment with Dr Gough in light of the site of the lesion, but she never did. On24 August 2021 , the Mother told Dr Rahman that [EX] was yet to meet the girls, when clearly on both of their written and oral evidence to this Court he had already met the girls in July 2021, if not earlier. I am satisfied that the Mother was lying on both occasions and that she did so because she was concerned about the girls’ presentation, which (at the very least) she recognised was unusual and could raise child protection questions.” [J192]”
“133. [EX] was clear in his evidence that the first time he met the girls was at a local park and that he travelled there by bicycle, which he rode from [Mr Z’s] house. He gave me a very detailed description about how the park was only a ten minutes bike ride away. Later in his evidence he realised that he had already told me that he first met the girls while he was still living in XXXXX, that is, before he had moved into [Mr Z’s] home. There is an obvious inconsistency in his account about when he first met the children. 134. Even allowing for the lapse of time and for issues about whether [EX] could remember matters clearly, I remain concerned about [EX’s] evidence to the Court. [EX] was emphatic that he has not caused the children sexual harm, nor would he ever do so. He was clear about this, as were the Mother and [BY]. However, I do not accept that [EX] has been as “up front” with the Court as he could have been about his involvement with the children and about where he was living at material times. These are material facts which are in dispute in this case and he needed to tell the Court about them. I am also, for similar reasons to the Mother, concerned about why he has not been open about these matters.”
“89. Dr Ongosi summarised her view as follows: “I don’t know of any other reasons, spontaneous or organic causes, which could have created the clinical findings I identified. The signs were clear and I am not doubtful about my findings. The examination of [ZY] and the re-examination as well as the examination of [YY], which was done by Dr Shaw, were all peer reviewed. We need at least five colleagues to peer review and I recall that senior colleagues were available and there is no disagreement as to the findings.” 90. Following Dr Ongosi’s evidence I heard from Dr Rahman. He is a Consultant Paediatrician who has been appointed as an independent expert in this case. He works for Harrogate NHS Trust and he has more than 30 years’ experience in this area. It was agreed that he should be present to listen to the entirety of Dr Ongosi’s evidence. As Dr Rahman explained, Dr Ongosi as the treating clinician gathered information and he as the Court appointed independent expert commented upon the information and provided an opinion. I considered him to be an extremely balanced and helpful witness. … 92. He carried out a careful analysis as to whether there were any organic causes or differential diagnoses and in summary he said this: “I can’t confirm that this is sexual abuse, but the possibility of it is high in this situation. There are the anal findings which are recognised as findings which are present in sexual abuse, plus the warts. I may not know for sure, but in terms of the possibilities the highest one I would say is of sexual abuse.”
“1. A Local Authority v AZ & Ors (children - 16, 15, 2 y/o respectively) The above matter was heard on 31 July -04 August 2023 , before Mrs Justice Lieven. The matter was reported:[2023] EWHC 3513 (Fam) . The detail of the case is below, using the anonymised initials as per the report: On01 November 2022 , DZ was examined by Dr Porter. Dr Porter concluded that there was a full thickness transection of the hymenal ring at 7 o'clock consistent with pre-menarchal penetration and a history of bleeding which was given. There was also some over healing between 1 and 2 o'clock, these findings were consistent with the history given. Dr Gray was instructed as an expert and reviewed Dr Porter's evidence and in essence agreed with her views, saying; "In this case, the forensic examination (01.11.22 at 1230) took place approximately two days after the last reported vaginal rape (30.10.22 at ~0900). Over this time, minor injuries (such as superficial abrasions or lacerations) could have healed without any sign. Furthermore, consensual sexual intercourse and vaginal rape after puberty do not necessarily cause genital injury. Therefore, in this case, acute signs of injury would not necessarily have been expected." The Court stated that in her original report and in the subsequent questions Dr Gray went somewhat outside her medical expertise, opining on the history of the allegations, the retractions and the story about the sex toy. The Judge placed no weight on these parts of Dr Gray's evidence given that the Judge was not confident that they fell within her expertise. The Court concluded that “the medical evidence in this case is not determinative. The evidence on the older hymenal defect, and whether it is indicative of an older injury may be consistent with normal variation. I feel it would be unsafe to rely on this. In respect of the healed laceration at 7 o'clock, that does seem to indicate that something occurred. Given that I have found the story about the sex toy impossible to believe, there is some evidence of sexual penetration, which fits with the allegation of abuse. However, given the lack of clarity over the medical evidence, I put very limited weight on this evidence.”
“Dr Gray has produced a clear overview of the two contemporaneous medical examinations of XX in May and June 2020 and has reached the unequivocal conclusion that Dr Porter, as the treating clinician in the latter examination, reached deductions which could not be sustained on the basis of the observed defects noted to XX’s hymen and anus, and that these potentially fell within normal limits. Having heard Dr Gray and read her reports, I am satisfied that her analysis of the examinations of XX is consistent both with the academic literature in this area and her professional experience of the dangers of overinterpreting what may very well be normal features in the development of a post-pubescent girl and cannot therefore support or undermine XX’s allegations in this case.” 3. A Local Authority v RM 2020 (“the Derby case”) The examination/report/analysis of the Paediatrician at SARC was criticised by Dr Gray who did not agree with the SARC conclusion that ano-genital findings were supportive of/consistent with sexual abuse, but rather that the findings were neutral i.e. did not support or refute the allegations. The LA did not seek to rely upon the SARC report for the s31 threshold. No evidence was given by SARC or Dr Gray. There was no Judgment in relation to this issue. Enquiries were made by the LA’s Solicitor with conduct, Ms Davies, with the LA who confirmed “There is a SARC medical on file from09/11/2020 ; this was not performed by any doctors you mention in the email below (this being the doctors at point 6 of the Order of04/07/2024 who peer reviewed Dr Ongosi in the current case), it was conducted by a Dr Porter at the Nottingham Children’s Hospital. The report was then looked at by a Dr Gray who prepared a report17/05/2021 for Court. This report of Dr Gray was critical of the SARC medical and conclusions, and Dr Gray did not agree with these conclusions. The LA did not pursue the sexual findings, there was other evidence and therefore, alterations were made to the threshold to deal with the matter in a different way. So, whilst Dr Gray was at one point on the witness template to give evidence in this case, the LA never had the information put to Court in witness format.” 4. An LCC case (“the Lincolnshire case”) in April 2024, where the examination was undertaken by Dr Sani-Omolori from SARC and Dr Gray, instructed as an independent expert, disagreed with her findings. The Council withdrew the application, inter alia on the basis of Dr Gray’s report. The detail of the case is below, using the anonymised initials as per the report: “Dr Gray has produced a clear overview of the two contemporaneous medical examinations of XX in May and June 2020 and has reached the unequivocal conclusion that Dr Porter, as the treating clinician in the latter examination, reached deductions which could not be sustained on the basis of the observed defects noted to XX’s hymen and anus, and that these potentially fell within normal limits. Having heard Dr Gray and read her reports, I am satisfied that her analysis of the examinations of XX is consistent both with the academic literature in this area and her professional experience of the dangers of overinterpreting what may very well be normal features in the development of a post-pubescent girl and cannot therefore support or undermine XX’s allegations in this case.”
“11. We follow the practice guidance laid out in RCPCH (“Royal College of Paediatrics and Child Health”) on peer review. We meet once a month and review as many cases as possible. I attach as exhibit JF1 a copy of the RCPCH guidance. As we follow this national guidance, there is no other separate standard operating procedure or Trust guidance on this. 12. Peer review is not a second opinion or ratification / authorisation of the original findings, or a part of the reporting process; the time scale in which the peer review takes place does not allow for delay in issuing the examination report pending this. Instead, the purpose of the peer review is to offer quality control and assurance that the findings and conclusions of the individual clinicians involved are shared by the wider group, and that they are in line with the body of accepted practice. It is to sense check the original report, not to second guess it. It is to assure us that the approach to examination and interpretation of the findings is in line with common practice, and identify anything that might be considered an outlier among common practice.”
“28. The note of the peer review of the26 October 2021 examination is signed by Dr Teh, consultant paediatrician. 29. The note of the peer review simply says: “DVD [we hold our images in encrypted DVD’s] – prepubertal bilateral scattered groin crease spots? Cause. Multiple anogenital warts but normal hymen Anus static anal external and internal dilatation and venous congestion ring with smooth absence of anal creases. No stools seen – Highly abnormal.”
“That examination was peer reviewed on10 March 2022 . In addition to Dr Ongosi, the attendees were myself, Dr James, Annie Richardson, Dr Sani-Omolori, Dr Straw and Dr Teh. The note makes clear that again there was no concern or doubt about Dr Ongosi’s findings, reading: “First exam Oct 2021 – wart x 2 at top of clitoral hood and multiple vestibular and periurethral warts With venous congestion and immediate external anal dilatation – No clear Hx of penile anal penetration Feb 2022 second exam – all warts resolved and much reduced anal dilatation Further actions? No.”
“From the extract of report 17/05/21 re Dr [Porter]’s examination in Derby Case a. Inadequate information of examiner’s training & experience b. Whether examiner’s work is routinely photo documented / peer reviewed c. Use of inappropriate / misleading phraseology / terms d. Absence of reference to other possible acts e. Inadequacy of medical / developmental history f. Reliance upon subjective and non-specific findings g. Lack of agreement with reported findings”
“Concerning Dr P’s report a. Absence of support by photo documentation in accordance with RCPCH guidelines for best practice b. Lack of agreement with reported findings – may represent normal variations c. Observed defect and skin tag may represent nothing more than normal variations to hymen and margin d. Dr Gray reached unequivocal conclusion that Dr P reached deductions which could not be sustained on the basis of the observed defects noted to XX’s hymen / anus and that these potentially fell within normal limits. Having heard Dr Gray and read her reports I am satisfied that her analysis of the examinations of XX is consistent both with the academic literature in this area and her professional experience of the dangers of overinterpreting what may very well be normal features…”
“a. Reliance on non-specific findings (redness / abrasions) b. Reliance on reported abrasions which were not visible in the colposcopic recording c. The non specific findings in context of history were characteristic of vulvovaginitis which is common condition in pre-pubertal girls. It is not an indicator of sexual abuse d. Absence of peer review minutes / record of peer review meeting e. Absence of details of examiner’s experience and qualifications / training & experience f. Use of inappropriate terminology g. Absence of detail of publications upon which opinion was based and of page / paragraph numbers of RCPCH guidance h. Dr Gray refers to fact updated version of RCPCH is expected to be published soon i. Incorrect / misleading quotation of figures j. Omission of stating alternative causes for erythema including medical conditions k. Reference to / reliance upon irrelevant comparison of findings l. Inconsistencies re rate of healing m. No agreement that injuries reported were present”