Professionals Against Child Abuse

Children are the most vulnerable members of society. Sometimes the very people who are expected to protect them place them at risk. It is then that professionals who work with children have a duty to protect them. PACA believes that vulnerable children need dedicated paediatricians, nurses, social workers, teachers and the law to protect them. PACA was formed in response to high profile cases against paediatricians at the General Medical Council at which it became clear that the present regulatory systems did not protect children and were open to abuse by those who sought to discredit professionals who stood up publicly for children's rights. PACA advocates for children's rights by campaigning for regulatory organisations to be trained in child protection, for the interests of the child to be paramount, and for professionals who stand up for children to receive fair treatment.

The Law Commission Consultation Paper on Expert Witnesses contains some mythology. PACA member David Murray penned this excellent response.

We have learnt over the last few years that no one and no profession is infallible. Some people can see the myths, but others are blind to them and are led by their prejudices.

Link to the Law Commission Consultation Paper on Expert Witnesses (PDF)

Text of the response by David Murray:

“You invite comments on the Consultation Paper.

PACA, is a group of Consultant Paediatricians and doctors together with lawyers, social workers and psychologists involved directly in Child Protection, or indirectly in the defence of doctors maligned in the media and punished by the General Medical Council for acting for the abused child against the abusers. May we ask you to consider the points made in the attached letter? We would be delighted to offer advice on the medical and forensic implications of working in this difficult field where our duty to children now requires us to defend ourselves against unfounded and often malicious commentary.

The Paper itself uses inaccurate evidence to illustrate poor medical and scientific expertise. It would make more sense to have used as an example of misleading expert evidence, not the Clark case, but a case in which such evidence had been shown conclusively to be in error, and for that error to have lead directly and materially to an unjust conviction, rather than to pick a case where the finding of murder was based on convincing medical and forensic argument remote from the supposed failings of expert witnesses, and then use that imagined failing to claim that such events are a problem. There is no “dogma that holds that two or more unexplained infant deaths should lead inexorably to the conclusion that a murder has been committed”, nor do Meadow or any other paediatricians cleave to it as the commissioners hold. There is no evidence that, “multiple cot deaths in a family could have underlying genetic causes”, nor can it be reliably stated that the occurrence of a second cot death is “usually from natural causes” when all, some, or none of such cases might be murder. How are we to reach sound conclusions as to the merits of procedures designed to protect against misleading opinion when the examples used to adduce such a necessity are so flawed that they discredit the real experts and take their lessons from the opportunist incompetent?

Meadow is not an example of flawed expertise but an expert traduced for being too astute and prescient. It was he who first realised that his ally in the comforting and treating of the sick child, its mother, may be the agent of its distress. Is it not odd that the country’s most distinguished expert in the misfortunes and murder of children should be the focus of an inquiry into flawed medical expertise? Is it not ironic that the wrong target has been selected with the expert of great value to the Court confused with the inexpert ‘expert’ who makes clinically implausible suggestions of a cause of death that are just sufficient to persuade the Court that there is a real dilemma and that justice is best served by prevarication?

Those who deserve scrutiny are not the leading figures in paediatric and forensic medicine but those whose imaginative diagnoses serve their purpose in Court but would be lethally dangerous if made at the bedside of a critically ill child: the retired haematologist who thinks Victoria Climbié died of a rare disease that inflicted marks on her body that seemed, to all but him, the indentation of the bicycle chain used to beat her, the retired biochemist with the first ever case of a novel syndrome to explain a child dying full of salt, the microbiologist who added to a dead baby’s list of injuries, typical of violent suffocating assault, the clinically unsound diagnosis of an infection of such ferocity that it overwhelmed the child in its bouncy chair in no more than ten minutes, the doctor flown in to say that dreadful injuries could have been caused by epilepsy rather than brutal contact with a banister rail. Constructive advocacy acts in the interest of clients but seldom for truth or the protection of vulnerable children. A great injustice has been done to Sir Roy Meadow and to the murdered children and should not be added to.”

The BMA has released a child protection tool kit for doctors.

From the site: The aim of this tool kit is to provide a brief and accessible guide to doctors’ responsibilities in child protection cases in England and Wales.

You can find out more here.

On the 1st of June, Panorama broadcast a programme entitled “A Very Dangerous Doctor”

This programme revealed the truth behind the Southall debacle.

Those of you who access this site might pass this link on to friends and colleagues.

http://www.bbc.co.uk/programmes/b00l6ds5

[Note: this programme can only be viewed from within the UK]

The Lancet expresses its view on the current situation in Child Protection, making an urgent suggestion: a UK Commission on Child Protection.

Lancet Child Protection editorial (PDF)

The outcome of the Southall appeal was astonishing. Read PACA’s letter published in the Lancet.

Lancet PACA letter (PDF)

Following the erasure of Dr David Southall from the GMC medical register.

PACA is saddened to learn that David Southall’s appeal in the High Court
today was unsuccessful in overturning the decision of the GMC’s Fitness to
Practise Committee to erase him from the medical register in December 2007.

The GMC have held three Fitness to Practise Hearings against David Southall:
in 2004, 2006-7 and in 2008. Only in the 2007 Hearing did the outcome lead
to a permanent restriction on David Southall’s ability to practise medicine.
PACA believes the GMC have acted inappropriately and have been improperly
influenced by a skilful and hostile media campaign by parents involved in
alleged child protection cases and their advocates. PACA is now concerned
that today’s result will have further serious and negative effects on the
willingness with which doctors will engage in child protection.

Internationally acclaimed and eminent paediatricians involved in child
protection have sustained repeated harassment in recent years, including
from the GMC. PACA considers that the GMC preliminary assessment procedures
have been ignorant of the nature of child protection procedures in the
Family Courts and that this case should never have been brought against
David Southall; that he has always given honestly held opinions, based on
extensive experience in complex child protection cases and solely with the
purpose of protecting children has never been questioned.

The disciplinary actions of the GMC, today supported by the High Court, will
be a further deterrent to paediatricians and other health professionals from
engagement in child protection work. Last year, the Royal College of
Paediatrics and Child Health voted overwhelmingly to express their grave
concerns about the GMC’s actions in the cases of both Professor Meadow and
David Southall. PACA considers today’s action will be a disservice to
children. The GMC should act only to encourage doctors to report child
protection concerns and engage in child protection work, by making them feel
safe from disciplinary actions, unless the doctor has been shown to have
acted incompetently or with malice.

We will provide full comment when we have read the full judgement.

[Update - the full judgement can be read here: Final_Southall_22_05_09.pdf (236 kb)]

Once again PACA is concerned to find information about the actions of the GMC in the case of a highly respected paediatrician involved in child protection work that shows a failure to follow natural justice and due process in their disciplinary procedures.

Dr Leonard Williams, who is a member of PACA, was asked to give evidence at a review fitness to practice hearing about Professor Southall at the GMC in 2008. His pre-hearing instructions were that he should accept the findings of the 2004 panel, and debate whether the sanctions imposed upon Professor Southall should be lifted. As such there was no need to read Professor Southall’s original report. In his written evidence, he accepted and reiterated the criticisms of the 2004 panel but argued that it was right, with the passage of time, to lift those sanction. However while giving oral evidence; he was questioned about the merits of the 2004 hearing.

Shortly after giving his evidence, Dr Williams was sent information which convinced him that some of the statements that he had made about the actions of Professor Southall in the Clark case had been incorrect. As required by the GMC’s own advice to expert witnesses, he was required to make this clear in writing to the panel/judge and he attempted to do this by writing to Professor Southall’s defence team, instructing that his letter be shown to the panel. An objection was raised to the entry of this letter and the legal assessor who works for the GMC advised that the panel should not see Dr Williams’ letter.

We find this decision almost unbelievable and once again reveals injustice meted out to Professor Southall. The result was that the GMC Panel criticised some of Professor Southall’s actions based on incorrect expert data. The media picked up the criticisms and ran with those rather than the main findings, which were that Professor Southall had been correct in contacting the child protection team following his viewing of a television programme that to him raised concerns about the safety of a child and a possible miscarriage of justice resulting in a mother being imprisoned. The GMC Panel also determined that the concerns he had raised about a nosebleed in a 6 week old baby 10 days before that baby was, according to the Criminal Court, suffocated, were not only appropriate but also supplemented by new research that had been published since his hearing before the GMC in 2004. The adverse reports in the media were also compounded by an article in the British Medical Journal which made strong reference to the criticisms. (NEWS: Southall is allowed to return to child protection work. Dyer BMJ 2008; 337: a1811)

One important consequence of this relates to Professor Southall’s imminent appeal in the High Court against the actions of the GMC in 2006-2007. The incorrect criticisms of some of Professor Southall’s report, produced for a pre-trial liaison meeting for the Family Court, may have impaired his Appeal if it wasn’t for the integrity of Dr Williams, who has made public the failure of the GMC to address his incorrect expert evidence.

Download this Press Release

Download the Letter

Read the Letter online on the BMJ website

Press Release - 10/02/2009

The GMC Fitness to Practise Committee has now acknowledged shortcomings, pointed out by PACA, in GMC procedures relating to complaints involving child protection. Following a Freedom of Information request, PACA has now discovered that the GMC plans to change its procedures.

The GMC acknowledged that they currently have no power to deal with serial or patently vexatious complainants, and that this may create unfairness for individual doctors who are either the specific target of a vexatious complainant or the random target of a serial complainant. Such circumstances are well recognised in Child Protection work, where some perpetrators of child abuse try and avoid responsibility for their actions by criticising the professionals involved.
The GMC has commented ‘the current rules do not provide us with the flexibility to deal as effectively as we would like with serial complaints or complaints that are clearly vexatious. Although such complaints are relatively uncommon, they can be very resource intensive and are unfair to doctors.’ At a meeting of the Fitness to Practice Committee in November 2008, GMC members agreed to pursue a change to their rules to allow them to reject serial or patently vexatious complaints.

A PACA spokesperson said ‘We are extremely pleased that the GMC has responded constructively to our reasoned arguments about the particular circumstances of complaints in Child Protection. Whilst we are in general highly supportive of the work of the GMC in maintaining professional standards to promote patient safety, we feel that the needs of children for protection were previously being overlooked. ‘

Doctors involved in this work may find themselves caught between the interests of parents and children, and may find themselves the subject of complaint by aggrieved parents who have been implicated in child abuse. As we see from the tragedy of cases like Victoria Climbie and others since, if children are to be properly protected, then professionals must be able to voice and act on reasonably held concerns without fear of being accused of malpractice. This GMC decision is a major step forward and we applaud them for it. ‘
Further information and comment is available from PACA via

http://www.paca.org.uk

Downloadable version of the press release (PDF)

PACA has been drawing attention for a long time to the GMC’s lack of a vexatious complaints policy. Vexatious complaints have been a serious problem for Health Professionals trying to safeguard children. For this reason as well as sending, out this press release, three PACA members have written a paper for publication in the Archives of Diseases of Childhood on A Way To Restore British Paediatricians’ Engagement With Child Protection Arch. Dis. Child. 2009 : adc.2008.154997v1

Here is the link:
http://adc.bmj.com/cgi/rapidpdf/adc.2008.154997v1

This is not the first reasoned comment published by OnMedica about safeguarding children. This one concerns the baby P case. We need to see clearly amidst all the tabloid encouraged anger.

Read the article online here
Download PDF here