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A: She's always been a vomity baby after she is fed, but no the person being vaccinated or, in the case of a child, the child's more than usual. parent or guardian. The handbook advises that consent should be Q: Did she have cold symptoms? obtained prior to each vaccination, after the recipient's fitness and A: She's had a snuffly chest and nose, she had a really bad suitability have been established, and that the person being vacci- reaction to the needles. She only had them on Wednesday; nated or the parent/guardian should be informed of all possible she had a runny nose since this. side effects. [Author's emphasis in italics.] It does appear that the medical practitioner in this instance was The fact that Rikki Lee had a bad reaction to vaccination was clearly negligent because he did not follow government guidelines also noted by the police in the "Report of Death to the Coroner", in the provision of vaccination services. He did not establish dated 23 April 1995: Rikki Lee's fitness for vaccination correctly, as she was subse- "The deceased received two-monthly injections on Wednesday quently found to have been suffering from viral pneumonia. 19.4.95 on her three-monthly period because she had been sick. Seventy-two hours later, disastrous results emerged from his care- The deceased then suffered a bad reaction to the injections; lessness. however, the mother did not return her to the doctor. [Signed by Following this vaccination, Rikki Lee slept for 10-11 hours on constable. ]" Friday night, 21 April 1995, the night before her death. Was this It is noted that the medical practitioner said the following in a "excessive somnolence"? This is defined by Peter O. Behan, statement to police: Professor of Neurology at Southern General Hospital, Glasgow, "I cannot recall this consultation; howev- as "a state of drowsiness" and is an adverse er, it [is] my usual practice to observe the reaction to vaccination. He wrote: "Albeit, child and ask general questions as to the this may be difficult to quantitate but, nor- child's health. If the child had been obvious- mally, mothers will be aware that the child ly unwell with fever, the vaccination would The father admitted that will be difficult to arouse, will not take its not have been ordered. Further, the child . . . food, and most mothers will note that the did not appear to have any physical injuries Rikki Lee, following the child is sleeping excessively." or [to be] suffering from neglect; and if the ini i According to the transcript from an addi- child had been, I am aware of the guidelines administration of the tional police interview, Scott Warren in relation to [my] contacting the vaccines, had shown Walters was asked about feeding details on Department of Community Services. The i i the day Rikki Lee died: child received the vaccinations from nursing signs of excessive A: ...she only, she didn't have it; she staff, as this is usually the normal practice at drowsiness, projectile wouldn't have been two minutes; she the centre." [Author's emphasis in italics.] itt i was on the bottle and she just... We know that the child was ill because vomiting and diarrhoea, Q: About two minutes on the bottle? had not been taking both parents alluded to this fact when A: Yeah. giving police statements. Did the med- Q: And what, she wasn't interest- ical practitioner give adequate informa- the full amount of her ed in the food? formula and was on continual doses of tion to the parents on the risks and ben- A: No, no. efits of vaccination so an informed The father admitted that Rikki Lee, Panadol every six hours. decision could be made? The father following the administration of the vac- alleged that the medical practitioner, in cines, had shown signs of excessive a consultation lasting three to four min- drowsiness, projectile vomiting and utes, did not take any notes of the con- diarrhoea, had not been taking the full sultation, did not examine the child for amount of her formula and was on con- contraindications to the administration tinual doses of Panadol every six hours. of a vaccine, did not question the par- ents on the health of the child, and did not explain the risks and benefits of LEGAL TEAM vaccination. In the case of Regina v Scott Warren If the medical practitioner did not recall the consultation, how Walters,’ heard by Acting Judge Black in the NSW Supreme could he remember whether there were any physical injuries or Court in April 1998, the Crown called three expert witnesses: a whether the child was suffering from neglect? Remember, the forensic pathologist, a paediatrician and a neuropathology doctor took no notes according to the parents. The doctor made professor. DOCTORS CALLED BY CROWN the statement: "If the child had been obviously unwell with fever, + The forensic pathologist reported: the vaccination would not have been ordered." We know, howev- "There were no fractures of the skull; subdural haemorrhage er, that the doctor admitted only to observing the child, so how was present diffusely across the superior surface of the right cere- could he make a diagnosis of whether the child had any con- bral hemisphere. There was no evidence of bruising of the neck. traindications for the administration of the six vaccines? There were no fractures of the rib cage. No digested food was The Australian Immunisation Procedures Handbook’ is distrib- seen in the intestine and there was minimal faecal material within uted by the National Health and Medical Research Council to give the colon. An X-ray skeletal survey was performed, and no evi- medical practitioners guidance about vaccination and to encour- dence of old or recent trauma or other bony disease was seen." age them to maintain the highest standards in the provision of Acting Judge Black commented on the forensic pathologist's vaccination services. The Sth edition of this handbook, distrib- testimony in his Judgment: uted in October 1994, is very clear on the issue of consent and "Examination of the fixed eyes noted haemorrhages around advises practitioners that informed consent must be obtained from both sides of the optic nerve and diffuse retinal haemorrhages... Rikki Lee, following the administration of the six hours. 36 + NEXUS formula and was on continual doses of Panadol every OCTOBER — NOVEMBER 2000