Frequently asked questions: The medical evidence

This is a particularly sensitive area: this page will address the forensic medical examinations performed by Dr Deborah Hodes on P and Q, the two children who were forced to make the original allegations.

The issues we’re raising are not just academic: they pertain to real, live children, whose lives are likely to be deeply affected by what’s published about them online. Thus we’re going to keep speculation to a minimum, and stick to exactly what is known—and in the public domain—concerning the examinations.

1. I’ve heard that the medical examinations proved conclusively that both children were sexually abused.

This is not true.

According to Mrs Justice Pauffley’s fact-finding judgement of 19 March 2015, Dr Hodes examined the children on 12 September 2014 in the left lateral position as recommended by the Royal College of Paediatrics and Child Health Review of 2008. This distinction is important.

In Child P, she found “three linear scars extending almost to the anal verge, as well as anal laxity after 10 seconds of gentle buttock traction”. In this examination, she found no sign of reflex anal dilatation.

In Child Q, she found “one anal fissure scar and no sign of reflex anal dilatation”.

These signs, in and of themselves, did not point specifically to sexual abuse.

However, Dr Hodes decided to conduct re-examinations of the children a few days later, on 16 September. At that time, the children provided graphic details of how they had been sexually abused, including the use of Vaseline on their “bottoms and willies”; they both said they’d experienced bleeding after the abuse, and that they’d been given tissues with which to wipe themselves.

The second examinations were done in the knee-chest position, and in this position Dr Hodes was able to see reflex anal dilatation in one of the children, P; in Q, she confirmed only a scar from a healed anal fissure.

Interestingly, when Dr Hodes took her findings to a peer review meeting in December 2014, she changed her mind about the significance of her original findings, and stated instead that the “previously confirmed fissures” were instead “irregularities in the ruggae” (folds, wrinkles, or ridges) of the anal area. At this time, she described their clinical significance as “possible normal variant”.

It’s hardly surprising that people are confused about Dr Hodes’ findings, which seem to veer from “possible” to “definite” to “possibly not” sexual abuse.

It’s also important to note that most doctors do not involve themselves this heavily in the cases for which they provide forensic examinations.

Dr Hodes not only examined the children twice, but also offered an opinion as to the validity of the children’s retractions, and held a long interview with Ella Draper after the children had retracted their allegations. In this interview, unsurprisingly, Ella reiterated the allegations as though they were true, and stated that RD, and not Abraham Christie, had been responsible for the signs of physical abuse detected in the children (bruises, contusions, ruptured ear drum).

The other troubling issue is that reflex anal dilatation, which Dr Hodes saw only in P, has been discredited as a definite sign of anal sexual abuse. It is seen in about one-third of children who have been anally abused, but it is also seen in up to 49% of non-abused children.

In her written reports, Dr Hodes made it clear that she believed the story the children had told, even after they had retracted it. In other words, she did not conduct her examinations in a neutral, fact-finding fashion, but rather went looking for signs that would confirm what she already believed.

Although her findings basically boiled down to one finding of reflex anal dilatation, which is not in itself diagnostic, Dr Hodes stated her belief that the children’s original claims were true—despite the fact that they were unsupported by evidence, and had been retracted. Even when confronted with the fact that Ella had given the children repeated enemas, and asked whether this would affect her conclusions, Dr Hodes stated that it would not; “it’s another source of trauma”, she said.

This is not the first time that Dr Hodes’ medical judgement has been clouded by her personal beliefs. Here’s a link to a blog post from March 2016, looking at another case in which she tried to use a finding of reflex anal dilatation to bolster a case in which no evidence of child sexual abuse could be found.

This extract from an article about forensic examination, taken from a professional journal (IPT Journal) helps to explain the difference between allegations and history:

Medical Exam findings-IPT Journal

2. I’ve read Dr Hodes’ evidence, and I think it backs up the children’s allegations that they were abused multiple times per week by members of a Satanic cult.

First, if the children really had been brutally abused, do you really think that Dr Hodes would have had to run a second examination to dig for evidence of that? There would have been much more evident scarring, had that been the case. And it would have occurred in both children.

Second, Dr Hodes never stated who she believed might have abused the children. She said she felt their original allegations should be taken seriously, which is true: all allegations of child sexual abuse ought to be treated with utmost seriousness. But it would be a huge stretch to claim that the medical evidence showed that one person or another had abused the children…even if the evidence on that matter was conclusive, which it was not.

3. Why was Dr Hodes’ evidence not used during the investigation to trigger arrests and seizure of phones and computers from those alleged to have abused the children?

On 12 September 2014, DS Fernandez contacted Social Services to obtain the results of Dr Hodes’ first medical examination, but was told that the file had not been updated yet. He then spoke to a social worker involved in the case, and was informed that the medical results were inconclusive in that the injury was not consistent with sexual assault.

Later that day, DS Fernandez spoke with Dr Hodes, who told him that she was alarmed at the accounts from the children, which she believed to be true; Child Q had one scar in his anus which could have been the result of passing waste; Child P had three scars and a degree of laxivity; Child P’s vaginal area was intact; both children claimed a degree of loss of hearing on the left side; and Child Q had a perforated eardrum which might have been caused by Abraham Christie.

The photographs which resulted from Dr Hodes’ second examination of the children were never passed to the police. Her 22 September report was finally handed to police in January 2015, long after the case had been closed.

Given Dr Hodes’ verbal communication—that while she believed the children’s reports, her medical findings had been inconclusive—the police had no reason to use her medical evidence to advance the case and start making arrests.

stethoscope and medical report

stethoscope and medical report

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  5. O RLY?

    Dr Hodes “confirms the physical findings of a scar in the anus from a healed
    fissure, consistent with inflicted injury from a blunt penetrating force that he has

    The only persisting physical sign post peer review was reflex anal dilatation in P
    which, so Dr Hodes, maintains is “consistent with her allegation of the blunt
    penetrating force to her anus i.e. sexual abuse.” In evidence she referred to her
    colleagues agreeing it was “abnormal and striking.” It is a sign which is “rarely
    seen.” In her written report she also said, “There is evidence in the literature that the
    absence of physical signs neither supports not (sic) refutes an allegation of anal
    penetration. In this case it was alleged that lubrication was used which adds to the
    probability of abuse.”


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