02/02/2023
A&E Referral:
Patient: Liam Cusack
Reason: suspected chest sepsis
Dear Colleague,
Can I please ask you to see this lovely 7 year old boy with suspected chest sepsis.
Presented with 3 day history of cough. He is a new patient to our practice so background unknown, but mum reports he would normally be chesty around Christmas time.
Cough is productive. Temps >40. High respiratory rate. Crepitations bibasally in lungs.
Likely chest sepsis.
Your input is greatly appreciated.
Brian Carson, GP.

12/02/2023
GP note:
Saw Liam in clinic with mum and step-father for follow up. Was admitted for 3 days. Given IV antibiotics.
Doing well, no concerns. Chest now clear.
BC.

28/10/2023
Fracture Clinic Discharge Letter:
Dear GP,
We reviewed Liam today and removed his arm cast.
As you are aware he suffered a humeral shaft fracture after sustaining an injury “rough housing” with his step-father.
He has been in a sling for the past 6 weeks. X-rays confirm good healing of the bone.
There is no neurovascular compromise.
He is to see the physiotherapist.
We have discharged him from Fracture Clinic.
Many thanks,
Dr Melissa Rahman, ST4 Orthopaedics.

20/01/2024
Community Paediatric Referral:
Patient: Liam Cusack
Reason: Suspected Autism
Dear Colleague,
Can I please ask you to see this lovely 8 year old boy with suspected Autism.
Mum very concerned regarding same. Has become increasingly withdrawn, low vocal tone, poor eye contact. Struggling to maintain friendships in school. Not wanting to engage in usual activities. Does not like being left alone, goes into tantrums. Very attached to mother. I’d be concerned regarding home situation but mum adamant no history of abuse.
Letter from mum and school report attached.
Many thanks,
Brian Carson, GP

18/02/2024
Internal Email to Mental Health Nurse:
Hi Sandra,
I’ve booked Jennifer Garvey (nee Cusack) in to see you tomorrow.
Just thought I’d give you a heads up. Mood’s low, anxious. A lot of stress at home; her son Liam is query autism, between jobs, and possible trouble in new marriage. She didn’t go into detail with me, but husband may have alcohol issues. Is keen to speak to you. If she thinks the husband would be open to Addiction’s referral just book him in with me.
Ta.
Brian.

01/03/2024
Addictions Referral:
Patient: Mark Garvey
Reason: Alcohol Abuse
Dear Colleague,
Can I please ask you to see this 41 year old gentleman with alcohol addiction.
Long history of alcohol abuse, states he has been referred to yourselves several times in the past. Has been daily drinking for the past few months, mostly cider, with spirits at weekends. Was previously on Antabuse but stopped last year. Would tend to go into DT’s when withdrawing. May require inpatient withdrawal given history.
Many thanks,
Brian Carson, GP

19/06/2024
GP note:
Liam is an 8 y/o boy who presented with penile pain. Attended with mum and step-father. It has been ongoing for 4 days. The glans and foreskin is red and tender. However there has been no discharge noted. Mum has been applying sudocrem with no improvement.
During the consultation Liam stated “my fucking cock is sore”. Extreme and inappropriate language for age, however I note he is currently awaiting assessment for autism.
Liam refused examination. He screamed and threw himself on the ground while attempting examination. Step-father offered to “pin him down”. I explained that was not necessary.
This is likely fungal balanitis.
Script for clotrimazole given to mum. It is to be applied three times a day. Mum is to recontact the surgery if it is not improving.
Dr Toner, locum GP

14/07/2024
GP notes:
I saw this boy in the surgery today at 4:30pm. He presents with spontaneous bruising without a clear cause. There is bruising across arms and legs, each approximately 1cm in size. His mother denies any trauma. There is no known bullying in school. He is also very lethargic and is sleeping a lot. He goes to bed after coming home from school. His diet is not good, so I encouraged him to take more green vegetables. I will check bloods today.
Dr Shaz, locum GP

16/07/2024
GP notes:
Bloods normal.
BC.

08/09/2024
GP notes:
Seen Liam in clinic with mum – burn on left forearm. Mum states burnt on straighteners when she was at work. Doesn’t remember leaving them on but states she must have. Step-father at home at time but has relapsed, drinking heavily. Too intoxicated to attend. No collaborative history.
No response from Liam. Mum now reports he is almost exclusively non-verbal. Still awaiting Paediatric input.
Burn appears clean, superficial. 5cm in length along medial forearm.
Mepitel dressing applied, for follow up with treatment room nurse in 5 days.
Explained to mum need for Social Services input due to burn. Mum upset but understands and consents. UNOCINI form completed and sent to Social Services.
BC.

13/09/2024
Treatment Room notes:
Did not attend for wound dressing. Spoke to step-father. Rebooked for Friday.

15/09/2024
Treatment Room notes:
Did not attend for wound dressing. No answer when contacted.

30/09/2024
GP notes:
Telephone call from Social Services. Unable to get in contact with mum or step father. Police phoned for welfare check. 
BC.

14/10/2024
Letter from Community Paediatrics:
Dear Colleague,
Many thanks for your referral of Liam Cusack. Unfortunately he did not attend his appointment.
He has been discharged from the service, as per policy.
He may be re-referred if still needing input.
Many thanks, Community Paediatrics.

19/10/2024
GP notes:
Telephone call from Social Services. They spoke with mum on phone. No concerns. Case closed.
Lauren, receptionist.

16/11/2024
Letter from Business Services Organisation (BSO):
Request transfer of notes to new GP – out of local area transfer.

23/12/2025
Letter from Coroner:
Request of full patient notes of Master Liam Cusack (DOB 24/09/2015) and any associated notes or correspondence.