Professionals Against Child Abuse

Article cited with kind permission of onmedica.com

A recent OnMedica poll of 589 doctors has found that 74% disagree with the General Medical Council’s decision to remove paediatrician David Southall from the medical register.

Dr Southall was struck off the register in December 2007 after being found guilty by the GMC of serious professional misconduct. The GMC decided Prof Southall’s conduct in a case where he accused a mother of drugging and murdering her son was an abuse of position and fundamentally incompatible with his continuing as a registered medical practitioner.

At the time of the ruling, the Royal College of Paediatrics and Child Health spoke out against the GMC’s decision, and paid tribute to the major contribution to child health made by Dr Southall during a distinguished career.

Kamran Abbasi, CEO of OnMedica, said: “The GMC was criticised for its decision at the time of the ruling. This poll proves that a large majority of doctors agree that Dr Southall should not have been struck off. It is important that doctors are not deterred from undertaking child protection work.”

Dr David Southall was erased from the medical register in December 2007 by the GMC. As it turns out this action was against the GMC’s own rules about erasure and he has subsequently been restored to the register pending appeal. In response to this volte face PACA issued the following press release outlining the issues facing the GMC in their case against Southall.

PACA has had major concerns about the General Medical Council’s Fitness to Practice procedures in high profile cases of paediatricians who have led the way in child protection work. PACA considers the GMC’s actions have reduced the willingness with which paediatricians will report suspicions of child abuse and engage in child protection work, including acting as expert witnesses. PACA has attempted to engage with the GMC, but Professor Catto, President of the GMC, and Finlay Scott, CEO, have responded that PACA is “painting a misleading picture, thus adding to the very problem they say they wish to resolve”.
 
However, last week, PACA’s concerns were overwhelmingly supported by a motion at the Annual General Meeting of the Royal College of Paediatrics and Child Health. The motion listed the areas of concern (see below) and called for the GMC to review the Fitness to Practice procedures as a matter of urgency. They recommended involvement of the RCPCH, the Department of Health, Department for Children, Schools and Families, Social Services Inspectorate and National Children’s Bureau. Unlike the GMC, these bodies better understand the relevant legislation and practice.

PACA is now further disturbed by the announcement today that the GMC failed to comply with its own regulations when they applied an immediate sanction against Professor Southall, resulting in his inability to work as a doctor. The GMC’s sanction led to Professor Southall’s immediate suspension from clinical and charity work, including his honorary medical directorship of the aid agency Childhealth Advocacy International (CAI).  This sanction was applied in the absence of evidence that his clinical or CAI work had caused any harm and had in fact brought enormous benefits to patients.  As a direct result of this sanction, Professor Southall had resigned from his consultant post at the University Hospital of North Staffordshire. Furthermore, the actions of the GMC against him have seriously impaired CAI’s ability to raise funds for its humanitarian aid work.

At least the GMC’s have conceded that they had made an error, resulting in cancellation of the suspension. However, it compounds their existing inability to regulate judiciously in cases involving leading child protection professionals. Given the GMC’s inability to recognise their error in erasing Professor Sir Roy Meadow from the medical register, described by a high court judge as approaching the irrational, and apologise to him, we have little expectation that the GMC will move forward with an urgent review of its procedures, as voted for at the RCPCH AGM. It is now time that the GMC reviewed the sanctions and erasure that they applied to Professor Southall’s cases in 2004 and 2007 respectively. In the view of PACA, they were both incorrect judgements.

Currently the GMC will receive complaints from anyone (having no vexatious complaints policy) – it then investigates and prosecutes these complaints, sits in judgement on its own investigation and finally decides what penalty should be applied. This is hardly a fair or balanced process and certainly not one that fulfils a doctor’s right to a fair hearing under Article 6 of the European Convention. Our experience of the GMC responses to its errors lead us only to conclude that it is incompetent and disingenuous in the way it attempts to defend the indefensible.

——

Motion for RCPCH AGM – York University, April 2008

The College has grave concerns about the actions of the GMC relating to proceedings involving child protection work directly or indirectly. These actions include:

1. The GMC erased from the register one paediatrician acting as an expert witness in a case where two children had died and where the mother was tried for murder. The erasure was quashed by the High Court, but the GMC have not acknowledged that the erasure decision was wrong and have not satisfactorily explained why they consider it is not related to the child protection field. As a consequence, paediatricians have been deterred from acting as expert witnesses in cases involving child injury or death, many of which would be classified as possible child protection cases.

2. The GMC sanctioned a paediatrician for reporting concerns to the statutory authorities for child protection and, describing the doctors’ behaviour as “precipitate” and criticising his evidence-based opinion given in good faith, found him guilty of serious professional misconduct and suspended him from further child protection work. This contravenes the stated professional and public duty to report child protection concerns and the latest guidance issued by the GMC itself. As a consequence, paediatricians now feel less certain of the correct way to proceed and may therefore be less likely to report child protection concerns.

3. The GMC erased from the register a paediatrician who was exploring with a parent the mechanism of death of their child at the request of social services in the context of care proceedings. The parent alleged that the paediatrician had accused her of murder, despite evidence to the contrary from the senior social worker present who along with the paediatrician took notes throughout the interview. As a consequence, many paediatricians are now more reluctant to participate in child death reviews or indeed explore with parents possible mechanisms for sudden death.

4. The GMC have repeatedly relied on an expert witness known to have opposing views to the doctor being investigated and who had advised contrary to that doctor in the first of the above cases. This raises serious questions about the impartiality of this expert, particularly as the GMC did not use any other expert evidence. As a consequence, paediatricians feel that GMC hearings in the field of child protection have not had the benefit of truly impartial advice representing current mainstream professional practice.

5. The GMC have undertaken a number of investigations on paediatricians who have already been the subject of investigations by other bodies and have been exonerated. The GMC have not inquired about such investigations, or have failed to take account of these previous investigations. We consider that this represents double jeopardy and demonstrates an unfair and incomplete process. As a consequence, paediatricians have become less willing to be involved in child protection work, knowing it may result in multiple complaints and investigations.

6. GMC registered doctors working in other specialities, who were convicted of various crimes, including assaults on children and viewing child pornography (offences which would render them unemployable as paediatricians) have been reinstated to the register. As a consequence, paediatricians feel treated more harshly than other specialities by the GMC.

7. The GMC does not automatically inform the doctor when it decides not to proceed with a complaint. College members know that complaints in child protection are rising and are under extreme and often public stress when they receive such a complaint. As a consequence, paediatricians are poorly informed by the GMC of progress in their own personal case.

8. The GMC is unwilling to state whether it has received multiple complaints from the same person(s) acting as part of a campaign against factitious and induced illness, quoting data protection legislation. Paediatricians have been asking the GMC to develop a policy for dealing with vexatious complaints and serial complainants. As a consequence, paediatricians feel the GMC is not taking their concerns on board.

For the above reasons, the College continues to have grave concerns over current GMC procedures for dealing with cases related to child protection. We call upon the GMC to review these procedures as a matter of urgency and involve in the review this College and other bodies such as the Department of Health, Department for Children, Schools and Families, Social Services Inspectorate and National Children’s Bureau, who have an understanding of the relevant legislation and practice, in order to support continued quality work by paediatricians in this field to the ultimate benefit of children and their families.

It is becoming clear that children remain at risk if they do not have the protection and advocacy of professionals. There has been an increase in violent crime against children according to figures from the NHS as published in the Observer, April 20 2008 by Jo Revill, Whitehall editor.

Observer article: http://www.guardian.co.uk/society/2008/apr/13/childprotection.health

There are many reasons for this, but it is the view of PACA that one major contributory factor is the increasing reluctance of doctors and other professionals to risk bringing concerns about child abuse to light for fear of condemnation and censure. The Guardian has published an article about this “climate of fear” (April 13 2008 by Gaby Hinsliff, political editor) which has arisen consequent to the GMC actions against Southall, Meadow and San Lazaro. The consequence of this “climate of fear” may be that in another 5 years we will see a further tragic rise in assaults on children.

Guardian article: http://www.guardian.co.uk/society/2008/apr/20/children.nhs

The GMC feel that this is not their responsibility and continue to repeat the same reassurances about numbers of paediatricians brought to fitness to practice hearings. PACA feels that the GMC figures do not reflect the true impact of the high profile cases; nor do their statements reflect the RCPCH work on this subject, as evidenced by the numerous unfilled child protection consultant posts.

The Guardian article, whilst being very helpful in highlighting many of the concerns that PACA seeks to publicise, has been challenged by David Southall. Southall’s concerns relate to details of Finlay Scott’s statement and some assumptions made in the text of the article. He has written a letter to the Guardian explaining this which was not published but reads as follows:

Bearing Good Witness: The Reluctant Experts, by Catherine Williams, Reader in Law, Sheffield University
[Republished with publisher's permission]

“In October 2006 the government launched a consultation document, Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases. The consultation closed in February 2007 and a summary of responses was published in July 2007. Prior to that, in a parliamentary statement on 17 June 2004, the Minister for Children, Young People and Families indicated that she had arranged for the Chief Medical Officer (CMO) to carry out an inquiry into how best to ensure the availability and quality of medical expert resources in court proceedings because there was an ‘acute problem … in finding experts of high standing to give medical evidence in proceedings’. She did not explain why this situation had arisen nor did she address the more acute problem. The unavailability of expert witnesses in proceedings is a symptom of the widespread reluctance of paediatricians, in particular, but also other professional staff, to be involved in child protection work in any respect. That reluctance was and is having a serious detrimental effect on the current arrangements for the protection of vulnerable children generally and will ensure that the narrower area of interest, that of experts being appointed for a specific purpose, will become even more difficult for want of the availability of sufficiently experienced professionals. The executive summary of Bearing Good Witness sets out the factors that, in the opinion of the CMO, deter doctors from being expert witnesses:

• few training programmes;

• court processes intimidating and stressful;

• court processes slow, bureaucratic and time consuming; and

• fear of referral to the General Medical Council (GMC) by vexatious parties.”[...]

To read the full article, please download it here

PACA letter to Safeguarding Children Boards, written 16th February 2008

“We are writing to you about the crisis in child protection following the decision in December by a GMC Fitness to Practise panel to erase Professor David Southall from the medical register. We are appealing to you as we believe that the effect of this case will be to deter paediatricians from acting in child protection matters. This can only place the most vulnerable children at even greater risk [...]“
To read the full letter, please download it here

Article from The Sentinel

Writer: Baronness Golding

It was I as the former MP for Newcastle under Lyme, who first asked for an investigation on the use of CNEP as a treatment for desperately ill babies with serious breathing problems. I did this following evidence shown to me by Mr and Mrs Henshall which was, for the main part, not directly related to the North Staffordshire Hospital. Since then, I have followed closely media reports of the various actions being taken against paediatricians, especially Dr Southall. I have often looked in disbelief at the virulent attacks on Dr Southall and have had many unquiet moments about the way I first dealt with Mr and Mrs Henshall’s concerns and whether I could have dealt with them in another way. This latest action by the General Medical Council in banning Dr Southall from working leaves all doctors at risk. When the third person in the room at the time spoke against the latest accusation, her independent evidence was not accepted by the GMC investigators. Where does that leave doctors’ protection against malicious patients?

Mike Wolfe’s recent column in The Sentinel on the evidence before the General Medical Council was ill informed and unbalanced, and follows the usual low standard of reporting on the case against Dr Southall.

I disagree totally with my colleague Paul Farrelly MP’s assertion that the GMC got its judgments absolutely right in banning Dr Southall from working. I have to say to him that listening to hospital gossip is not the best way to judge anyone. All doctors have their critics, some more vocal than others.

Have Dr Southall’s critics ever seen babies struggling for each breath? Have they ever looked into the face of a policewoman as she brings yet another small, unkempt and dead baby into the accident unit? Have they ever seen a mother half smother a baby and then cry out for help that the child has stopped breathing? Have they ever seen the strain on the faces of dedicated people as they struggle to bring sanity to the lives of children who have been serially abused? Have they ever listened to the words of denial of adults for the broken limbs or sickness of their children who have been serially abused? Have they ever looked into the eyes of children whose fear is locked inside them? These things I have seen. Dr Southall and other paediatricians will have seen such things many, many times. They will ask, as I have often done – who speaks for the child?

My contribution was to spend year after year as an MP, fighting to get the law changed to let children’s voices be heard in the courts. My battle was won – Dr Southall and others like him can never and should never stop being the voice of the child.

When I first met Dr Southall I was impressed by his commitment to help and protect children. Nothing that has happened since has led me to think I was wrong. Only a person who believed in what he was doing could survive the abuse he and other paediatricians have put up with for so long. I ask the question, why? These doctors hae, over the years, worked in a spotlight where their every moved was liable to be questioned. In whose interest? At what cost? The medical world should never stand still. Adults’ voices can always be heard, but who should speak for the child?

Mr Farrelly has said that “sorry” and “apologise” appear not to be in Dr Southall’s personal dictionary. I hope they are, because I wish to apologise to him and say how sorry I am if my initial concern has given fuel o what can only be described as a witch hunt, aided and abetted by some professional people who surely should know better.

Baroness Golding

Letter written in response to Private Eye article in edition 1120, (21-12-07 – 11-1-08)

The Eye, regrettably, did not publish this letter.

23 Dec 07

Dear Lord Gnome

In its 40 year history, Private Eye has never evinced any particular knowledge of, nor interest in, children: and perhaps that is why you have allowed yourself to print, in your esteemed organ, so totally wrong an article as appears in Medicine Balls, Eye 1120.

Regrettably, the Chief Executive of the General Medical Council, whom you quote verbatim, appears to be just as ill informed about child protection work as was the remarkably under powered GMC panel which judged Professor Southall. It would be more in the tradition of the Eye if you had taken the time to query this voice of authority, rather than swallowing his inaccurate message whole, and publicising it with no apparent analysis.

As a paediatrician, I can choose a path where I am quite unlikely to face criticism: care for children with any condition under the sun, but keep well away from child abuse. Alternatively, I can take child abuse seriously. This I should do: for 75 children (or more) die each year as a result of abuse or neglect, by their families, in the UK. Which means that there are plenty of other children suffering as a result of abuse or neglect, by their families. But if I do take child abuse seriously, then I am extremely likely to be complained about.

There have been no enquiries into my professional work – except as a result of complaints from parents aggrieved because I raised the possibility of abuse concerning their children. And my experience mirrors that of other paediatricians.

If we reach the stage that paediatricians choose to do the other work (which also needs doing) but avoid child protection work because of the effect on themselves and their families, then the very many children suffering abuse and neglect will be even less well protected than they are now.

It is unfortunate that your organ has chosen a line which – against your best traditions – means that on this occasion you are not supporting the underdog. Quite the reverse. You are supporting the forces which would have us believe that child abuse is quite uncommon – and, in particular, it does not occur in ‘nice’ families. I’m disappointed that your standards have slipped in this way.

I recommend that you read the ‘Open letter to the General Medical Council’ in the British Medical Journal of 15 Dec 07: if you do so, you will be better informed. And possibly your organ will be better informed also.

Yours sincerely,

Peter Ehrhardt

Letter to The Guardian newspaper -Wednesday December 5, 2007

We are extremely concerned at the direction taken by child protection in this country. This concern is made more acute following yesterday’s decision at the GMC to strike David Southall’s name from the medical register. There is a determined campaign to deny the existence and reality of child abuse in all its forms, led by a small group, aided and abetted by some journalists and politicians. This group targets prominent professionals in the field, especially paediatricians. Unable to respond publicly, there is no counterbalancing voice for the cause of abused children, so the media presents a completely one-sided picture.

In recent years, numerous competent, sincere and committed paediatricians have suffered at the hands of this lobby, both from complaints to employing bodies, but more seriously to the General Medical Council. The GMC overreacted in the case of Roy Meadow, where their decision to erase him from the medical register was reversed on appeal. We have also denounced the GMC’s 2004 decision about David Southall (“GMC Fails Child Protection”, Pediatrics 2007).
The recent decision in David Southall’s case (Controversial paediatrician reprimanded again, November 28) further shows their lack of understanding of child protection practice. The GMC has failed to understand the dilemmas faced by paediatricians when the circumstances around a child’s death raise concerns of child abuse and the emotional conflict it generates when this diagnosis needs to be discussed with bereaved parents, devastated by the loss of their child.
The GMC’s recent finding discounted the testimony of David Southall and the accompanying senior social worker. This means that no doctor can rely on an independent professional witness who testifies that they acted appropriately and professionally in a consultation. Given the sensitivity around discussing possible life-threatening abuse, paediatricians appear to have no defence against complaints from aggrieved parents who may have abused their children. This will mean many more paediatricians will avoid engagement in this work. The decision is thus not only a major injustice to Professor Southall, but also to vulnerable children.
The GMC ignores the law: “The well-being of innumerable children up and down the land depends crucially on doctors and social workers concerned with their safety being subjected by the law to but a single duty: that of safeguarding the child’s own welfare.” Paediatricians and social workers in this field must be supported rather than vilified in their efforts to protect children. The GMC decision inhibits doctors from acting within a multi-agency team to protect children.
John Bridson, Nigel Speight, Margaret Crawford, Malcolm Coulthard, Loretta Davis-Reynolds, Charles Essex, Frank Hind, Sherin Jackson, Nadeem Moghal, Peter Morrell, Umesh Prabhu, Tabitha Randell and 26 others

Professionals Against Child Abuse

In an interview during Saturday’s edition of the Today programme on Radio 4 (8th December 2007), Mr. Finlay Scott, Chief Executive of the General Medical Council, gave out false information about the number of doctors who have been brought before the GMC in connection with child protection cases.

Mr Scott told the interviewer, John Humphrys, that PACA had ”unfortunately created the impression that the GMC unfairly persecutes paediatricians involved in child protection work and that’s simply not borne out by the facts”.

He added: “Since I think 2004, during which time we’ve probably had five or six hundred cases before Fitness to Practise panels, only two could reasonably be said to have had any connection with child protection work.”

This is not true. PACA knows of at least five doctors who have been brought before the GMC since 2004 on charges relating to their actions in child protection cases. These are Professors Meadow and Southall and Drs Lazaro, Spender and Paterson. PACA challenges Mr Scott to issue a statement disclosing the true figure. Mr Scott also knows that three of these 5 cases involve world leaders in child protection and that through the high profile media activities that accompanied the fitness to practice hearings that most paediatricians who have admired and been led by these doctors will have been severely discouraged and worried by the very fact that they reached full hearings let alone by the erasure from the register that followed for Professors Meadow and Southall

It is also disingenuous of Mr Scott to create the impression that paediatricians’ concerns are based solely on the number of complaints that have reached the panel stage. He knows full well that it was the GMC’s decision not only to bring the recently heard charges against David Southall but to produce such a perverse finding with draconian sanctions that has undermined the confidence of doctors working in child protection.

Child-protection work invariably means raising uncomfortable suspicions about parents. Some of these suspicions will prove well founded, some will not. To ensure doctors will not hesitate to raise such concerns, providing they have raised them in good faith they are immune to legal action taken by aggrieved parents. The GMC has unilaterally rendered this immunity meaningless by replacing the threat of legal action with the even greater threat of the loss of livelihood.

Released: 4/12/2007

Dr Southall has been a courageous defender of abused children and it is his dedication to that cause that has made him a high-profile target for a group of activists working on behalf of parents accused of child abuse.

Today’s decision, a victory for this group, is utterly perverse and we condemn it unreservedly, not only because we believe it represents a grotesque miscarriage of justice but also because it sends out a simple message to any doctor so much as thinking about engaging in child protection: ‘Don’t bother. It isn’t worth it; you will lose your livelihood.’ I needn’t spell out where that leaves abused children.

Dr Southall was found guilty of accusing a mother of murder nine years ago. He says he did not and it was up to the GMC to prove that he did. They proved no such thing. Instead, they chose to believe the uncorroborated evidence of a naturally aggrieved mother and to reject Dr Southall’s version of events, even though it was endorsed by the evidence of the senior social worker who had sat through the interview in question.

Paediatricians are disgusted and disillusioned and if the government doesn’t sit up and take notice of what is going on in this country I fear for the future of child protection

Professionals Against Child Abuse (PACA)